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MEDICAL ESSAYS 



1842-1882 



BY 



OLIVER WENDELL HOLMES 




BOSTON 
HOUGHTON, MIFFLIN AND COMPANY 

New York: 11 East Seventeenth Street 

<2T6e fttoertft&e $re£j, CambriDoe 
1890 






? 



£. 



Copyright, 1861, 1862, 1883, 1889, and 1890 
BY OLIVER WENDELL HOLMES 

All rights reserved. 



The Riverside Press, Cambridge, Mass., U. S. A. 
Electrotyped and Printed by H. 0. Houghton & Company. 



PREFACE TO THE NEW EDITION. 



These Lectures and Essays are arranged in the 
order corresponding to the date of their delivery or 
publication. They must, of course, be read with a 
constant reference to these dates, by such as care to 
read them. I have not attempted to modernize their 
aspect or character in presenting them, in this some- 
what altered connection, to the public. Several of 
them were contained in a former volume which re- 
ceived its name from the Address called " Currents 
and Counter-Currents." Some of those contained in 
the former volume have been replaced by others. The 
Essay called " Mechanism of Yital Actions " has been 
transferred to a distinct collection of Miscellaneous 
Essays, forming a separate volume. 

I had some intention of including with these papers 
an Essay on Intermittent Fever in New England, 
which received one of the Boylston prizes in 1837, and 
was published in the following year. But as this was 
upon a subject of local interest, chiefly, and would 
have taken up a good deal of room, I thought it best 
to leave it out, trusting that the stray copies to be met 
with in musty book-shops would sufficiently supply the 
not very extensive or urgent demand for a paper al- 
most half a century old. 

Some of these papers created a little stir when they 



IV PREFACE TO THE NEW EDITION. 

first fell from the press into the pool of public con- 
sciousness. They will slide in very quietly now in 
this new edition, and find out for themselves whether 
the waters are those of Lethe, or whether they are 
to live for a time as not wholly unvalued reminis- 
cences 

March 21, 1883. 



PREFACE. 



The character of the opposition which some of these 
papers have met with suggests the inference that they 
contain really important, but unwelcome truths. Neg- 
atives multiplied into each other change their sign 
and become positives. Hostile criticisms meeting 
together are often equivalent to praise, and the square 
of fault-finding turns out to be the same thing as 
eulogy. 

But a writer has rarely so many enemies as it 
pleases him to believe. Self-love leads us to overrate 
the numbers of our negative constituency. The larger 
portion of my limited circle of readers must be quite 
indifferent to, if not ignorant of, the adverse opinions 
which have been expressed or recorded concerning 
any of these Addresses or Essays now submitted to 
their own judgment. It is proper, however, to in- 
form them, that some of the positions maintained in 
these pages have been unsparingly attacked, with va- 
rious degrees of ability, scholarship, and good-breed- 
ing. The tone of criticism naturally changes with 
local conditions in different parts of a country ex- 
tended like our own, so that it is one of the most 
convenient gauges of the partial movements in the 
direction of civilization. It is satisfactory to add, 
that the views assailed have also been unflinchingly 



VI PREFACE. 

defended by unsought champions, among the ablest of 
whom it is pleasant to mention, at this moment of po- 
litical alienation, the Editor of the Charleston Medical 
Journal. 

" Currents and Counter-Currents " was written and 
delivered as an Oration, a florid rhetorical composi- 
tion, expressly intended to secure the attention of an 
audience not easy to hold as listeners. It succeeded 
in doing this, and also in being as curiously misunder- 
stood and misrepresented as if it had been a political 
harangue. This gave it more local notoriety than it 
might otherwise have attained, so that, as I learn, one 
ingenious person made use of its title as an advertise- 
ment to a production of his own. 

The commonest mode of misrepresentation was this : 
qualified propositions, the whole meaning of which de- 
pended on the qualifications, were stripped of these 
and taken as absolute. Thus, the attempt to establish 
a presumption against giving poisons to sick persons 
was considered as equivalent to condemning the use 
of these substances. The only important inference 
the writer has been able to draw from the greater 
number of the refutations of his opinions which have 
been kindly sent him, is that the preliminary educa- 
tion of the Medical Profession is not always what it 
ought to be. 

One concession he is willing to make, whatever 
sacrifice of pride it may involve. The story of Mas- 
sasoit, which has furnished a coral, as it were, for 
some teething critics, when subjected to a powerful 
logical analysis, though correct in its essentials, proves 
to have been told with exceptionable breadth of state- 
ment, and therefore (to resume the metaphor) has 
been slightly rounded off at its edges, so as to be 



PREFACE. Vll 

smoother for any who may wish to bite upon it here- 
after. In other respects the Discourse has hardly been 
touched. It is only an individual's expression, in his 
own way, of opinions entertained by hundreds of the 
Medical Profession in every civilized country, and has 
nothing in it which on revision the writer sees cause 
to retract or modify. The superstitions it attacks lie 
at the very foundation of Homoeopathy, and of almost 
every form of medical charlatanism. Still the mere 
routinists and unthinking artisans in most callings 
dislike whatever shakes the dust out of their tradi- 
tions, and it may be unreasonable to expect that 
Medicine will always prove an exception to the rule. 
One half the opposition which the numerical system 
of Louis has met with, as applied to the results of 
treatment, has been owing to the fact that it showed 
the movements of disease to be far more independent 
of the kind of practice pursued than was agreeable 
to the pride of those whose self-confidence it abated. 

The statement, that medicines are more sparingly 
used in physicians' families than in most others, ad- 
mits of a very natural explanation, without putting a 
harsh construction upon it, which it was not intended 
to admit. Outside pressure is less felt in the physi- 
cian's own household ; that is all. If this does not 
sometimes influence him to give medicine, or what 
seems to be medicine, when among those who have 
more confidence in drugging than his own family 
commonly has, the learned Professor Dunglison is 
hereby requested to apologize for his definition of the 
word Placebo, or to expunge it from his Medical 
Dictionary. 

One thing is certain. A loud outcry on a slight 
touch reveals the weak spot in a profession, as well as 



Vlli PREFACE. 

in a patient. It is a doubtful policy to oppose the 
freest speech in those of our own number who are try- 
ing to show us where they honestly believe our weak- 
ness lies. Vast as are the advances of our Science 
and Art, may it not possibly prove on examination 
that we retain other old barbarisms beside the use of 
the astrological sign of Jupiter, with which we en- 
deavor to insure good luck to our prescriptions ? Is 
it the act of a friend or a foe to try to point them out 
to our brethren when asked to address them, and is the 
speaker to subdue the constitutional habit of his style 
to a given standard, under penalty of giving offence 
to a grave assembly ? 

" Homoeopathy and its Kindred Delusions " was 
published nearly twenty years ago, and has been long 
out of print, so that the author tried in vain to procure 
a copy until the kindness of a friend supplied him 
with the only one he has had for years. A foolish 
story reached his ears that he was attempting to buy 
up stray copies for the sake of suppressing it. This 
edition was in the press at that very time. 

Many of the arguments contained in the Lectures 
have lost whatever novelty they may have possessed. 
All its predictions have been submitted to the formi- 
dable test of time. They appear to have stood it, so 
far, about as well as most uninspired prophecies ; in- 
deed, some of them require much less accommodation 
than certain grave commentators employ in their read- 
ings of the ancient Prophets. 

If some statistics recently published 2 are correct, 
Homoeopathy has made very slow progress in Europe. 

1 Medical Investigator. Devoted to the Advancement of the 
Homozpathic System of Medicine. Chicago, January 1, 1861. 



PREFACE. IX 

In all England, as it appears, there are hardly a fifth 
more Homoeopathic practitioners than there are stu- 
dents attending Lectures at the Massachusetts Medi- 
cal College at the present time. In America it has 
undoubtedly proved more popular and lucrative, yet 
how loose a hold it has on the public confidence is 
shown by the fact that, when a specially valued life, 
which has been played with by one of its agents, is 
seriously threatened, the first thing we expect to hear 
is that a regular practitioner is by the patient's bed, 
and the Homceopathie counsellor overruled or dis- 
carded. Again, how many of the ardent and capri- 
cious persons who embraced Homoeopathy have run 
the whole round of pretentious novelties ; — have 
been boarded at water-cure establishments, closeted 
with uterine and other specialists, and finally wan- 
dered over seas to put themselves in charge of foreign 
celebrities, who dosed them as lustily as they were ever 
dosed before they took to globules ! It will surprise 
many to learn to what a shadow of a shade Homoeop- 
athy has dwindled in the hands of many of its noted 
practitioners. The itch-doctrine is treated with con- 
tempt. Infinitesimal doses are replaced by full ones 
whenever the fancy-practitioner chooses. Good Ho- 
moeopathic reasons can be found for employing any- 
thing that anybody wants to employ. Homoeopathy 
is now merely a name, an unproved theory, and a box 
of pellets pretending to be specifics, which, as all of 
us know, fail ignominiously in those cases where we 
would thankfully sacrifice all our prejudices and give 
the world to have them true to their promises. 

Homoeopathy has not died out so rapidly as Tracto- 
ration. Perhaps it was well that it should not, for it 
has taught us a lesson of the healing faculty of Na- 



X PREFACE. 

ture which was needed, and for which many of us 
have made proper acknowledgments. But it probably 
does more harm than good to medical science at the 
present time, by keeping up the delusion of treating 
everything by specifics, — the old barbarous notion 
that sick people should feed on poisons, 1 against which 
a part of the Discourse at the beginning of this volume 
is directed. 

The infinitesimal globules have not become a curi- 
osity as yet, like Perkins's Tractors. But time is a 
very elastic element in Geology and Prophecy. If 
Daniel's seventy weeks mean four hundred and ninety 
years, as the learned Prideaux and others have set- 
tled it that they do, the " not many years " of my pre- 
diction may be stretched out a generation or two be- 
yond our time, if necessary, when the prophecy will 
no doubt prove true. 

It might be fitting to add a few words with regard 
to the Essay on the Contagiousness of Puerperal Fe- 
ver. But the whole question I consider to be now 
transferred from the domain of medical inquiry to 
the consideration of Life Insurance agencies and 
Grand Juries. Por the justification of this somewhat 
sharply accented language I must refer the reader to 
the paper itself for details which I regret to have been 
forced to place on permanent record. 

Boston, January, 1861. 

1 Lachesis, arrow-poison, obtained from a serpent (Pulte). 
Croialus hdrridas, rattlesnake's venom (Neidhard). The less 
dangerous Pediculua capitis is the favorite remedy of Dr. Mure, 
the English " Apostle of Homoeopathy." These are examples of 
the retrograde eurrent setting towards barbarism. 



CONTENTS. 



PAGE 
I. HOMCEOPATHY AND ITS KlNDRED DELUSIONS . . 1 

II. The Contagiousness of Puerperal Fever . . 103 
IIL Currents and Counter-Currents in Medical Sci- 
ence 173 

IV. Border Lines of Knowledge in some Provinces of 

Medical Science 209 

V. Scholastic and Bedside Teaching .... 273 
"VI. The Medical Profession in Massachusetts . 312 

VII. The Young Practitioner 370 

VIII. Medical Libraries 396 

IX. Some of my Early Teachers 420 



MEDICAL ESSAYS, 
i. 

HOMOEOPATHY AND ITS KINDRED DELUSIONS." 

Kairvov cttias uuap. 

[When a physician attempts to convince a person, who has fallen into 
the Homoeopathic delusion, of the emptiness of its pretensions, he is often 
answered by a statement of cases in which its practitioners are thought to 
have effected wonderful cures. The main object of the first of these Lec- 
tures is to show, by abundant facts, that such statements, made by persons 
unacquainted with the fluctuations of disease and the fallacies of observa- 
tion, are to be considered in general as of little or no value in establishing 
the truth of a medical doctrine or the utility of a method of practice. 

Those kind friends who suggest to a person suffering from a tedious 
complaint, that he "Had better try Homoeopathy," are apt to enforce 
their suggestion by adding, that "at any rate it can do no harm." This 
mayor may not be true as regards the individual. But it always does very 
great harm to the community to encourage ignorance, error, or deception 
in a profession which deals with the life and health of our fellow-creatures. 
Whether or not those who countenance Homoeopathy are guilty of this 
injustice towards others, the second of these Lectures may afford them 
some means of determining. 

To deny that good effects may happen from the observance of diet and 
regimen when prescribed by Homceopathists as well as by others, would 
be very unfair to them. But to suppose that men with minds so consti- 
tuted as to accept such statements and embrace such doctrines as make up 
the so-called science of Homoeopathy are more competent than others to 
regulate the circumstances which influence the human body in health and 
disease, would be judging very harshly the average capacity of ordinary 
practitioners. 

To deny that some patients may have been actually benefited through 
the influence exerted upon their imaginations, would be to refuse to Ho- 
moeopathy what all are willing to concede to every one of those numerous 
modes of practice known to all intelligent persons by an opprobrious title. 

« Two lectures delivered before the Boston Society for the Diffusion of Useful 
Knowledge. 1842. 

1 



2 MEDICAL ESSAYS. 

So long as the bod}' is affected through the mind, no audacious device, 
even of the most manifestly dishonest character, can fail of producing 
occasional good to those who yield it an implicit or even a partial faith. 
The argument founded on this occasional good would be as applicable in 
justifying the counterfeiter and giving circulation to his base coin, on the 
ground that a spurious dollar had often relieved a i>oor man's necessiti 

Homoeopathy has come before our public at a period when the growing 
spirit of eclecticism has prepared many ingenious and honest minds to listen 
to all new doctrines with a candor liable to degenerate into weakness. It 
is not impossible that the pretended evolution of great and mysterious vir- 
tues from infinitely attenuated atoms may have enticed a few over-refining 
philosophers, who have slid into a vague belief that matter subdivided 
grows less material, and approaches nearer to a spiritual nature as it re- 
quires a more powerful microscope for its detection. 

However this may be, some persons seem disposed to take the ground of 
Menzel. that the Laity must pass formal judgment between the Physician 
and the Homoeopathist, as it once did between Luther and the Romanists. 
The practitioner and the scholar must not, therefore, smile at the amount of 
time and labor expended in these Lectures upon this shadowy system; 
which, in the calm and serious judgment of many of the wisest members 
of the medical profession, is not entitled by anything it has ever said or 
done to the notoriety of a public rebuke, still less to the honors of critical 
martyrdom.] 

I. 

I have selected four topics for this lecture, the first 
three of which I shall touch but slightly, the last more 
fully. They are 

1. The Royal cure of the King's Evil, or Scrofula. 

2. The Weapon Ointment, and. its twin absurdity, 
the Sympathetic Powder. 

3. The Tar-water mania of Bishop Berkeley. 

4. The History of the Metallic Tractors, or Per- 
kinism. 

The first two illustrate the ease with winch numer- 
ous facts are accumulated to prove the most fanciful 
and senseless extravagances. 

The third exhibits the entire insufficiency of exalted 
wisdom, immaculate honesty, and vast general acquire- 
ments to make a good physician of a great bishop. 

The fourth shows us the intimate machinery of an 



HOMOEOPATHY AND ITS KINDRED DELUSIONS. 3 

extinct delusion, which flourished only forty years ago ; 
drawn in all its details, as being a rich and compara- 
tively recent illustration of the pretensions, the argu- 
ments, the patronage, by means of which windy errors 
have long been, and will long continue to be, swollen 
into transient consequence. All display in superflu- 
ous abundance the boundless credulity and excitability 
of mankind upon subjects connected with medicine. 



From the time of Edward the Confessor to Queen 
Anne, the monarchs of England were in the habit of 
touching those who were brought to them suffering 
with the scrofula, for the cure of that distemper. 
William the Third had good sense enough to discon- 
tinue the practice, but Anne resumed it, and, among 
her other patients, performed the royal operation upon 
a child, who, in spite of his disease, grew up at last 
into Samuel Johnson. After laying his hand upon 
the sufferers, it was customary for the monarch to 
hang a gold piece around the neck of each patient. 
Very strict precautions were adopted to prevent those 
who thought more of the golden angel hung round the 
neck by a white ribbon, than of relief of their bodily 
infirmities, from making too many calls, as they some- 
times attempted to do. " According to the statement 
of the advocates and contemporaries of this remedy, 
none ever failed of receiving benefit unless their little 
faith and credulity starved their merits. Some are 
said to have been cured immediately on the very touch, 
others did not so easily get rid of their swellings, until 
they were touched a second time. Several cases are 
related, of persons who had been blind^ for several 
weeks, and months, and obliged even to be led to 



4 MEDICAL ESSAYS. 

"Whitehall, yet recovered their sight immediately upon 
being touched, so as to walk away without any guide." a 
So widely, at one period, was the belief diffused, 
that, in the course of twelve years, nearly a hundred 
thousand persons were touched by Charles the Sec- 
ond. Catholic divines, in disputes upon the ortho- 
doxy of their church, did not deny that the power 
had descended to protestant princes ; — Dr. Harps- 
field, in his " Ecclesiastical History of England," ad- 
mitted it, and in Wiseman's words, " when Bishop 
Toolccr would make use of this Argument to prove 
the Truth of our Church, Sniitheus doth not there- 
upon go about to deny the Matter of fact; nay, both 
he and Cope acknowledge it." " I my self," says 
Wiseman, the best English surgical writer of his day, 
— "I my self have been a frequent Eye-witness of 
many hundred of Cures performed by his Majesties 
Touch alone, without any assistance of Chirurgery ; 
and those, many of them such as had tired out the 
endeavours of able Chirurgeons before they came 
hither. It were endless to recite what I myself have 
seen, and what I have received acknowledgments of 
by Letter, not only from the severall parts of this Na- 
tion, but also from Ireland, Scotland, Jersey >, Gam- 
sey. It is needless also to remember what Miracles 
of this nature were performed by the very Bloud of 
his late Majesty of Blessed memory, after whose dec- 
ollation by the inhuman Barbarity of the Regicides, 
the reliques of that were gathered on Chip:: and in 
Handkerchiefs by the pious Devotes, who could not 
but think so great a suffering in so honourable and 
pious a Cause, would be attended by an extraordi- 
nary assistance of God, and some more then ordinary 
a Edinburgh Medical and Surgical Journal, vol. iii. p. 103. 



HOMCEOPATHY AND ITS KINDRED DELUSIONS. 5 

miracle : nor did their Faith deceive them in this 
there point, being so many hundred that found the 
benefit of it." a 

Obstinate and incredulous men, as he tells us,- ac- 
counted for these cures in three ways : by the journey 
and change of air the patients obtained in coming to 
London ; by the influence of imagination ; and the 
wearing of gold. 

To these objections he answers, — 1st. That many 
of those cured were inhabitants of the city. 2d. That 
the subjects of treatment were frequently infants. 
3d. That sometimes silver was given, and sometimes 
nothing, yet the patients were cured. 

A superstition resembling this probably exists at 
the present time in some ignorant districts of Eng- 
land and this country. A writer in a Medical Jour- 
nal in the year 1807, speaks of a farmer in Devon- 
shire, who, being a ninth son of a ninth son, is 
thought endowed with healing powers like those of 
ancient royalty, — and who is accustomed one day 
in every week to strike for the evil. 

I remember that one of my schoolmates told me, 
when a boy, of a seventh son of a seventh son, some- 
where in Essex County, who touched for the scrofula, 
and who used to hang a silver fourpence halfpenny 
about the neck of those who came to him, which 
fourpence halfpenny it was solemnly affirmed became 
of a remarkably black color after having been some 
time worn, and that his own brother had been sub- 
jected to this extraordinary treatment; but I must 
add that my schoolmate drew a bow of remarkable 
length, strength, and toughness for his tender years. 



a Severall Chirurgicall Treatises. London. 1676. p. 246. 



6 MEDICAL ESSAYS. 

One of the most curious examples of the fallacy of 
popular belief and the uncertainty of asserted facts 
in medical experience is to be found in the history of 
the Unguent um Armarium, or Weapon Ointment. 

Fabricius Hildanus, whose name is familiar to every 
surgical scholar, and Lord Bacon, who frequently 
dipped a little into medicine, are my principal au- 
thorities for the few circumstances I shall mention 
regarding it. The Weapon Ointment was a prepara- 
tion used for the healing of wounds, but instead of 
its being applied to them, the injured part was washed 
and bandaged, and the weapon with which the wound 
was inflicted was carefully anointed with the un- 
guent. Empirics, ignorant barbers, and men of that 
sort, are said to have especially employed it. Still 
there were not wanting some among the more respect- 
able members of the medical profession who sup- 
ported its claims. The composition of this ointment 
was complicated, in the different formula given by 
different authorities ; but some substances addressed 
to the imagination, rather than the wound or weapon, 
entered into all. Such were portions of mummy, of 
human blood, and of moss from the skull of a thief 
hung in chains. 

Hildanus was a wise and learned man, one of the 
best surgeons of his time. He was fully aware that a 
part of the real secret of the Unguentum Armarium 
consisted in the washing and bandaging the wound 
and then letting it alone. But he could not resist 
the solemn assertions respecting its efficacy ; he gave 
way before the outcry of facts, and therefore, instead 
of denying all their pretensions, he admitted and 
tried to account for them upon supernatural grounds. 
As the virtue of those applications, he says, which 



HOMCEOPATHY AND ITS KINDRED DELUSIONS. 7 

are made to the weapon cannot reach the wound, and 
as they can produce no effect without contact, it fol- 
lows, of necessity, that the Devil must have a hand 
in the business ; and as he is by far the most long- 
headed and experienced of practitioners, he cannot 
find this a matter of any great difficulty. Hildanus 
himself reports, in detail, the case of a lady who had 
received a moderate wound, for which the Unguen- 
tum Armarium was employed without the slightest 
use. Yet instead of receiving this flat case of failure 
as any evidence against the remedy, he accounts for 
its not succeeding by the devout character of the 
lady, and her freedom from that superstitious and 
over-imaginative tendency which the Devil requires 
in those who are to be benefited by his devices. 

Lord Bacon speaks of the Weapon Ointment, in his 
Natural History, as having in its favor the testimony 
of men of credit, though, in his own language, he 
himself " as yet is not fully inclined to believe it." 
His remarks upon the asserted facts respecting it 
show a mixture of wise suspicion and partial belief. 
He does not like the precise directions given as to the 
circumstances under which the animals from which 
some of the materials were obtained were to be 
killed ; for he thought it looked like a provision for 
an excuse in case of failure, by laying the fault to 
the omission of some of these circumstances. But 
he likes well that " they do not observe the confect- 
ing of the Ointment under any certain constellation ; 
which is commonly the excuse of magical medicines, 
when they fail, that they were not made under a fit 
figure of heaven." a It was pretended that if the 

a This was a mistake, however, since the two recipes given by 
Hildanus are both very explicit as to the aspect of the heavens 
required for different stages of the process. 



8 MEDICAL ESSAYS. 

offending weapon could not be had, it would serve 
the purpose to anoint a wooden one made like it. 
" This," says Bacon, " I should doubt to be a device 
to keep this strange form of cure in request and use ; 
because many times you cannot come by the weapon 
itself." And in closing his remarks on the statements 
of the advocates of the ointment, he says, " Lastly, 
it will cure a beast as well as a man, which I like 
best of all the rest, because it subjecteth the matter 
to an easy trial." It is worth remembering, that 
more than two hundred years ago, when an absurd 
and fantastic remedy was asserted to possess won- 
derful power, and when sensible persons ascribed its 
pretended influence to imagination, it was boldly 
answered that the cure took place when the wounded 
party did not know of the application made to the 
weapon, and even when a brute animal was the sub- 
ject of the experiment, and that this assertion, lie as 
we all know it was, came in such a shape as to shake 
the incredulity of the keenest thinker of his time. 
The very same assertion has been since repeated in 
favor of Perkinism, and, since that, of Homoeopathy. 

The same essential idea as that of the Weapon 
Ointment reproduced itself in the still more famous 
Sympathetic Powder. This Powder was said to 
have the faculty, if applied to the blood-stained gar- 
ments of a wounded person, to cure his injuries, 
even though he were at a great distance at the time. 
A friar, returning from the East, brought the recipe 
to Europe somewhat before the middle of the sevc~, 
teenth century. The Grand Duke of Florence, in 
which city the friar was residing, heard of his cures, 
and tried, but without success, to obtain his secret. 
Sir Kenelm Digby, an Englishman well known to 



HOMCEOPATHY AND ITS KINDRED DELUSIONS. 9 

fame, was fortunate enough to do him a favor, which 
wrought upon his feelings and induced him to impart 
to his benefactor the composition of his extraordinary- 
Powder. This English knight was at different peri- 
ods of his life an admiral, a theologian, a critic, a meta- 
physician, a politician, and a disciple of Alchemy. 
As is not unfrequent with versatile and inflamma- 
ble people, he caught fire at the first spark of a new 
medical discovery, and no sooner got home to Eng- 
land than he began to spread the conflagration. 

"An opportunity soon offered itself to try the 
powers of the famous powder. Mr. J. Howell, having 
been wounded in endeavoring to part two of his 
friends who were fighting a duel, submitted himself 
to a trial of the Sympathetic Powder. Four days 
after he received his wounds, Sir Kenelm dipped one 
of Mr. Howell's garters in a solution of the Powder, 
and immediately, it is said, the wounds, which were 
very painful, grew easy, although the patient, who 
was conversing in a corner of the chamber, had not 
the least idea of what was doing with his garter. 
He then returned home, leaving his garter in the 
hands of Sir Kenelm, who had hung it up to dry, 
when Mr. Howell sent his servant in a great hurry 
to tell him that his wounds were paining him horri- 
bly ; the garter was therefore replaced in the solution 
of the Powder, and the patient got well after five or 
six days of its continued immersion." 

" King James First, his son Charles the First, the 
Duke of Buckingham, then prime minister, and all 
the principal personages of the time, were cognizant 
of this fact ; and James himself, being curious to 
know the secret of this remedy, asked it of Sir 
Kenelm, who revealed it to him, and his Majesty had 



10 MEDICAL ESSAYS. 

the opportunity of making several trials of its efficacy, 
which all succeeded in a surprising manner." a 

The king's physician, Dr. Mayerne, was made mas- 
ter of the secret, which he carried to France and com- 
municated to the Duke of Mayenne, who performed 
many cures by means of it, and taught it to his sur- 
geon, who, after the Duke's death, sold it to many 
distinguished persons, by whose agency it soon ceased 
to be a secret. What was this wonderful substance 
which so astonished kings, princes, dukes, knights, and 
doctors ? Nothing but powdered blue vitriol. But it 
was made to undergo several processes that conferred 
on it extraordinary virtues. Twice or thrice it was to 
be dissolved, filtered, and crystallized. The crystals 
were to be laid in the sun during the months of June, 
July, and August, taking care to turn them carefully 
that all should be exposed. Then they were to be 
powdered, triturated, and again exposed to the sun, 
again reduced to a very fine powder, and secured in a 
vessel, while hot, from the sunshine. If there seem 
anything remarkable in the fact of such astonishing 
properties being developed by this process, it must be 
from our short-sightedness, for common salt and char- 
coal develop powers quite as marvellous after a certain 
number of thumps, stirs, and shakes, from the hands 
of modern workers of miracles. In fact the linemen- 
turn Armarium and Sympathetic Powder resemble 
some more recent prescriptions ; the latter consisting 
in an infinite dilution of the common dose in which 
remedies are given, and the two former in an infinite 
dilution of the common distance at which they are 
applied. 

° Diet, des Sciences Medicates. 



HOMCEOPATHY AND ITS KINDRED DELUSIONS. 11 

'Whether philosophers, and more especially meta- 
physicians, have any peculiar tendency to dabble in 
drugs and dose themselves with physic, is a question 
which might suggest itself to the reader of their biog- 
raphies. 

When Bishop Berkeley visited the illustrious Male- 
branche at Paris, he found him in his cell, cooking in 
a small pipkin a medicine for an inflammation of the 
lungs, from which he was suffering ; and the disease, 
being unfortunately aggravated by the vehemence of 
their discussion, or the contents of the pipkin, carried 
him off in the course of a few days. Berkeley him- 
self afforded a remarkable illustration of a truth which 
has long been known to the members of one of the 
learned professions, namely, that no amount of talent, 
or of acquirements in other departments, can rescue 
from lamentable folly those who, without something 
of the requisite preparation, undertake to experiment 
with nostrums upon themselves and their neighbors. 
The exalted character of Berkeley is thus drawn by 
Sir James Mackintosh : " Ancient learning, exact sci- 
ence, polished society, modern literature, and the fine 
arts, contributed to adorn and enrich the mind of this 
accomplished man. All his contemporaries agreed 
with the satirist in ascribing 

" ' To Berkeley every virtue under heaven.' 

" Even the discerning, fastidious, and turbulent At- 
terbury said, after an interview with him, ' So much 
understanding, so much knowledge, so much inno- 
cence, and such humility, I did not think had been the 
portion of any but angels, till I saw this gentleman.' ' 

But among the writings of this great and good man 
is an Essay of the most curious character, illustrat- 



12 MEDICAL ESSAYS. 

ing his weakness upon the point in question, and enti- 
tled, " Siris, a Chain of Philosophical Reflections and 
Inquiries concerning the Virtues of Tar Water, and 
divers other Subjects," — an essay which begins with 
a recipe for his favorite fluid, and slides by gentle 
gradations into an examination of the sublimest doc- 
trines of Plato. To show how far a man of honesty 
and benevolence, and with a mind of singular acute- 
ness and depth, may be run away with by a favorite 
notion on a subject which his habits and education do 
not fit him to investigate, I shall give a short account 
of this Essay, merely stating that as all the supposed 
virtues of Tar Water, made public in successive edi- 
tions of his treatise by so illustrious an author, have 
not saved it from neglect and disgrace, it may be fairly 
assumed that they were mainly imaginary. 

The bishop, as is usual in such cases, speaks of him- 
self as indispensably obliged, by the duty he owes to 
mankind, to make his experience public. Now this 
was by no means evident, nor does it follow in general, 
that because a man has formed a favorable opinion of 
a person or a thing he has not the proper means of 
thoroughly understanding, he shall be bound to print 
it, and thus give currency to his impressions, which 
may be erroneous, and therefore injurious. He would 
have done much better to have laid his impressions 
before some experienced physicians and surgeons, such 
as Dr. Mead and Mr. Cheselden, to have asked them 
to try his experiment over again, and have been guided 
by their answers. But the good bishop got excited ; he 
pleased himself with the thought that he had discov- 
ered a great panacea ; and having once tasted the be- 
witching cup of self-quackery, like many before and 
since his time, he was so infatuated with the draught 



HOMOEOPATHY AND ITS KINDRED DELUSIONS. 13 

that he would insist on pouring it down the throats of 
his neighbors and all mankind. 

The precious fluid was made by stirring a gallon of 
water with a quart of tar, leaving it forty-eight hours, 
and pouring off the clear water. Such was the spe- 
cific which the great metaphysician recommended for 
averting and curing all manner of diseases. It was, 
if he might be believed, a preventive of the small-pox, 
and of great use in the course of the disease. It 
was a cure for impurities of the blood, coughs, pleu- 
risy, peripneumony, erysipelas, asthma, indigestion, ca- 
chexia, hysterics, dropsy, mortification, scurvy, and 
hypochondria. It was of great use in gout and fevers, 
and was an excellent preservative of the teeth and 
gums ; answered all the purpose of Elixir Proprietatis, 
Stoughton's drops, diet drinks, and mineral waters ; 
was particularly to be recommended to sea-faring per- 
sons, ladies, and men of studious and sedentary lives ; 
could never be taken too long, but, on the contrary, 
produced advantages which sometimes did not begin 
to show themselves for two or three months. 

" From my representing Tar Water as good for so 
many things," says Berkeley, " some perhaps may con- 
clude it is good for nothing. But charity obligeth me 
to say what I know, and what I think, however it may 
be taken. Men may censure and object as they please, 
but I appeal to time and experiment. Effects mis- 
imputed, cases wrong told, circumstances overlooked, 
perhaps, too, prejudices and partialities against truth, 
may for a time prevail and keep her at the bottom of 
her well, from whence nevertheless she emergeth sooner 
or later, and strikes the eyes of all who do not keep 
them shut." I cannot resist the temptation of illus- 
trating the bishop's belief in the wonderful powers 



14 MEDICAL ESSAYS. 

of his remedy, by a few sentences from different parts 
of his essay. " The hardness of stubbed vulgar consti- 
tutions renders them insensible of a thousand things 
that fret and gall those delicate people, who, as if their 
skin was peeled off, feel to the quick everything that 
touches them. The tender nerves and low spirits of 
such poor creatures would be much relieved by the 
use of Tar Water, which might prolong and cheer their 
lives." " It [the Tar Water] may be made stronger 
for brute beasts, as horses, in whose disorders I have 
found it very useful." " This same water will also 
give charitable relief to the ladies, who often want it 
more than the parish poor ; being many of them never 
able to make a good meal, and sitting pale, puny, and 
forbidden, like ghosts, at their own table, victims of 
vapors and indigestion." It does not appear among 
the virtues of Tar Water that " children cried for it," 
as for some of our modern remedies, but the bishop 
says, " I have known children take it for above six 
months together with great benefit, and without any 
inconvenience ; and after long and repeated experience 
I do esteem it a most excellent diet drink, fitted to all 
seasons and ages." After mentioning its usefulness 
in febrile complaints, he says : "I have had all this 
confirmed by my own experience in the late sickly 
season of the year one thousand seven hundred and 
forty-one, having had twenty-five fevers in my own 
family cured by this medicinal water, drunk copi- 
ously." And to finish these extracts with a most im- 
portant suggestion for the improvement of the British 
nation : " It is much to be lamented that our Insulars, 
who act and think so much for themselves, should yet, 
from grossness of air and diet, grow stupid or doat 
sooner than other people, who, by virtue of elastic air, 



HOMOEOPATHY AND ITS KINDRED DELUSIONS. 15 

water-drinking, and light food, preserve their faculties 
to extreme old age ; an advantage which may perhaps 
be approached, if not equaled, even in these regions, 
by Tar Water, temperance, and early hours." 

Berkeley died at the age of about seventy ; he might 
have lived longer, but his fatal illness was so sudden 
that there was not time enough to stir up a quart of 
the panacea. He was an illustrious man, but he held 
two very odd opinions ; that tar water was everything, 
and that the whole material universe was nothing. 



Most of those present have at some time in their 
lives heard mention made of the Metallic Trac- 
tors, invented by one Dr. Perkins, an American, and 
formerly enjoying great repute for the cure of vari- 
ous diseases. Many have seen or heard of a satirical 
poem, written by one of our own countrymen also, 
about forty years since, and called " Terrible Tractora- 
tion." The Metallic Tractors are now so utterly aban- 
doned that I have only by good fortune fallen upon a 
single one of a pair, to show for the sake of illustra- 
tion. For more than thirty years this great discovery, 
which was to banish at least half the evils which afflict 
humanity, has been sleeping undisturbed in the grave 
of oblivion. Not a voice has, for this long period, 
been raised in its favor ; its noble and learned patrons, 
its public institutions, its eloquent advocates, its bril- 
liant promises are all covered with the dust of silent 
neglect ; and of the generation which has sprung up 
since the period when it flourished, very few know 
anything of its history, and hardly even the title which 
in its palmy days it bore of Perkinism. Taking it as 
settled, then, as no one appears to answer for it, that 



16 MEDICAL ESSAYS. 

Perkinism is entirely dead and gone, that both in pub- 
lic and private, officially and individually, its former 
adherents even allow it to be absolutely defunct, I se- 
lect it for anatomical examination. If this pretended 
discovery was made public ; if it was long kept before 
the public ; if it was addressed to the people of dif- 
ferent countries ; if it was formally investigated by 
scientific men, and systematically adopted by benev- 
olent persons, who did everything in their power to 
diffuse the knowledge and practice of it ; if various 
collateral motives, such as interest and vanity, were 
embarked in its cause ; if, notwithstanding all these 
things, it gradually sickened and died, then the con- 
clusion seems a fair one, that it did not deserve to live. 
Contrasting its failure with its high pretensions, it is 
fair to call it an imposition ; whether an expressly fraud- 
ulent contrivance or not, some might be ready to ques- 
tion. Everything historically shown to have happened 
concerning the mode of promulgation, the wide diffu- 
sion, the apparent success of this delusion, the respect- 
ability and enthusiasm of its advocates, is of great in- 
terest in showing to what extent and by what means a 
considerable part of the community may be led into 
the belief of that which is to be eventually considered 
as an idle folly. If there is any existing folly, fraud- 
ulent or innocent in its origin, which appeals to cer- 
tain arguments for its support ; provided that the very 
same arguments can be shown to have been used for 
Perkinism with as good reason, they will at once fall 
to the ground. Still more, if it shall appear that the 
general course of any existing delusion bears a strong 
resemblance to that of Perkinism, that the former is 
most frequently advocated by the same class of per- 
sons who were conspicuous in behalf of the latter, and 



HOMOEOPATHY AND ITS KINDRED DELUSIONS. 17 

treated with contempt or opposed by the same kind of 
persons who thus treated Perkinism ; if the facts in 
favor of both have a similar aspect ; if the motives of 
their originators and propagators may be presumed to 
have been similar ; then there is every reason to sup- 
pose that the existing folly will follow in the footsteps 
of the past, and after displaying a given amount of 
cunning and credulity in those deceiving and deceived, 
will drop from the public view like a fruit which has 
ripened into spontaneous rottenness, and be succeeded 
by the fresh bloom of some other delusion required by 
the same excitable portion of the community. 

Dr. Elisha Perkins was born at Norwich, Connect- 
icut, in the year 1740. He had practised his profes- 
sion with a good local reputation for many years, when 
he fell upon a courss of experiments, as it is related, 
which led to his great discovery. He conceived the 
idea that metallic substances might have the effect of 
removing diseases, if applied in a certain manner ; a 
notion probably suggested by the then recent experi- 
ments of Galvani, in which muscular contractions were 
found to be produced by the contact of two metals 
with the living fibre. It was in 1796 that his dis- 
covery was promulgated in the shape of the Metallic 
Tractors, two pieces of metal, one apparently iron 
and the other brass, about three inches long, blunt at 
one end and pointed at the other. These instruments 
were applied for the cure of different complaints, such 
as rheumatism, local pains, inflammations, and even 
tumors, by drawing them over the affected part very 
lightly for about twenty minutes. Dr. Perkins took 
out a patent for his discovery, and travelled about the 
country to diffuse the new practice. He soon found 
numerous advocates of his discovery, many of them of 



18 MEDICAL ESSAYS. 

high standing and influence. In the year 1798 the 
tractors had crossed the Atlantic, and were publicly em- 
ployed in the Royal Hospital at Copenhagen. About 
the same time the son of the inventor, Mr. Benjamin 
Douglass Perkins, carried them to London, where they 
soon attracted attention. The Danish physicians pub- 
lished an account of their cases, containing numerous 
instances of alleged success, in a respectable octavo 
volume. In the year 1804 an establishment, honored 
with the name of the Perkinean Institution, was 
founded in London. The transactions of this institu- 
tion were published in pamphlets, the Perkinean So- 
ciety had public dinners at the Crown and Anchor, 
and a poet celebrated their medical triumph in strains 
like these : — 

'' Sec, pointed metals^ blest witb power t' appease 
The. ruthless rage of merciless disease, 
O'er the frail part a subtle fluid pour, 
Drenched with invisible Galvanic shower, 
Till the arthritic staff and crutch forego, 
And leap exulting like the bounding roe ! " 

While all these things were going on, Mr. Benja- 
min Douglass Perkins was calmly pocketing money, 
so that after some half a dozen years he left the coun- 
try with more than ten thousand pounds, which had 
been paid him by the believers in Great Britain. But 
in spite of all this success, and the number of those in- 
terested and committed in its behalf, Perkinism soon 
n to decline, and in 1811 the Tractors are spoken 
of by an intelligent writer as being almost forgotten. 
Such was the origin and duration of this doctrine and 
practice, into the history of which Ave will now look a 
little more narrowly. 

Let us see, then, by whose agency this delusion 



HOMOEOPATHY AND ITS KINDRED DELUSIONS. 19 

was established and kept up ; whether it was princi- 
pally by those who were accustomed to medical pur- 
suits, or those whose habits and modes of reasoning 
were different ; whether it was with the approbation 
of those learned bodies usually supposed to take an 
interest in scientific discoveries, or only of individuals 
whose claims to distinction were founded upon their 
position in society, or political station, or literary em- 
inence ; whether the judicious or excitable classes en- 
tered most deeply into it; whether, in short, the scien- 
tific men of that time were deceived, or only intruded 
upon, and shouted down for the moment by persons 
who had no particular call to invade their precincts. 

Not much, perhaps, was to be expected of the 
Medical Profession in the way of encouragement. 
One Dr. Fuller, who wrote in England, himself a 
Perkinist, thus expressed his opinion : " It must be 
an extraordinary exertion of virtue and humanity for 
a medical man, whose livelihood depends either on 
the sale of drugs, or on receiving a guinea for writing 
a prescription, which must relate to those drugs, to 
say to his patient, ' You had better purchase a set of 
Tractors to keep in your family ; they will cure you 
without the expense of my attendance, or the danger 
of the common medical practice.' For very obvious 
reasons medical men must never be expected to rec- 
ommend the use of Perkinism. The Tractors must 
trust for their patronage to the enlightened and phil- 
anthropic out of the profession, or to medical men 
retired from practice, and who know of no other 
interest than the luxury of relieving the distressed. 
And I do not despair of seeing the day when but 
very few of this description as well as private famines 
will be without them." 



20 MEDICAL ESSAYS. 

Whether the motives assigned by this medical man 
to his professional brethren existed or not, it is true 
that Dr. Perkins did not gain a great deal at their 
hands. The Connecticut Medical Society expelled 
him in 1797 for violating their law against the use of 
nostrums, or secret remedies. The leading English 
physicians appear to have looked on with singular 
apathy or contempt at the miracles which it was pre- 
tended were enacting in the hands of the apostles of 
the new practice. In looking over the reviews of the 
time, I have found little beyond brief occasional 
notices of their pretensions ; the columns of these 
journals being occupied with subjects of more per- 
manent interest. The state of tilings in London is 
best learned, however, from the satirical poem to 
which I have already alluded as having been written 
at the period referred to. This was entitled, " Terri- 
ble Traetoration ! ! A Poetical Petition against Gal- 
vanizing Trumpery and the Perkinistic Institution. 
Most respectfully addressed to the Royal College of 
Physicians, by Christopher Caustic, M. D., LL. D., 
A. S. S., Fellow of the Royal College of Physicians, 
Aberdeen, and Honorary Member of no less than 
nineteen very learned Societies." Two editions of 
this work were published in London in the years 
1803 and 1804, and one or two have been published 
in this country. 

" Terrible Traetoration " is supposed, by those who 
never read it, to be a satire upon the follies of Per- 
kins and his followers. It is, on the contrary, a most 
zealous defence of Perkinism, and a fierce attack 
upon its opponents, most especially upon such of the 
medical profession as treated the subject with neglect 
or ridicule. The Royal College of Physicians was the 



HOMCEOPATHY AND ITS KINDRED DELUSIONS. 21 

more peculiar object of the attack, but with this body, 
the editors of some of the leading periodicals, and sev- 
eral physicians distinguished at that time, and even 
now remembered for their services to science and hu- 
manity, were involved in unsparing denunciations. 
The work is by no means of the simply humorous 
character it might be supposed, but is overloaded with 
notes of the most seriously polemical nature. Much 
of the history of the subject, indeed, is to be looked 
for in this volume. 

It appears from this work that the principal mem- 
bers of the medical profession, so far from hailing Mr. 
Benjamin Douglass Perkins as another Harvey or 
Jenner, looked very coldly upon him and his Trac- 
tors ; and it is now evident that, though they were 
much abused for so doing, they knew very well what 
they had to deal with, and were altogether in the 
right. The delusion at last attracted such an amount 
of attention as to induce Dr. Haygarth and some 
others of respectable standing to institute some exper- 
iments which I shall mention in their proper place, 
the result of which might have seemed sufficient to 
show the emptiness of the whole contrivance. 

The Royal Society, that learned body which for 
ages has constituted the best tribunal to which Britain 
can appeal in questions of science, accepted Mr. 
Perkins's Tractors and the book written about them, 
passed the customary vote of thanks, and never 
thought of troubling itself further in the investiga- 
tion of pretensions of such an aspect. It is not to 
be denied that a considerable number of physicians 
did avow themselves advocates of the new practice ; 
but out of the whole catalogue of those who were 
publicly proclaimed as such, no one has ever been 



22 MEDICAL ESSAYS. 

known, so far as I am aware, to the scientific world, 
except in connection with the short-lived notoriety 
of Perkinism. Who were the people, then, to whose 
activity, influence, or standing with the community 
was owing all the temporary excitement produced by 
the Metallic Tractors ? 

First, those persons who had been induced to pur- 
chase a pair of Tractors. These little bits of brass 
and iron, the intrinsic value of which might, perhaps, 
amount to ninepence, were sold at five guineas a 
pair ! A man who has paid twenty-five dollars for 
his whistle is apt to blow it louder and longer than 
other people. So it appeared that when the " Per- 
kinean Society " applied to the possessors of Tractors 
in the metropolis to concur in the establishment of a 
public institution for the use of these instruments 
upon the poor, " it was found that only five out of 
above a hundred objected to subscribe, on account of 
their want of confidence in the efficacy of the prac- 
tice ; and these," the committee observes, " there is 
reason to believe, never gave them a fair trial, proba- 
bly never used them in more than one case, and that 
perhaps a case in which the Tractors had never been 
recommended as serviceable." " Purchasers of the 
Tractors,*' said one of their ardent advocates, " would 
be among the last to approve of them if they had rea- 
son to suppose themselves defrauded of five guineas." 
He forgot poor Moses, with his " gross of green spec- 
tacles, with silver rims and shagreen cases." " Dear 
mother," cried the boy, " why won't you listen to 
reason ? I had them a dead bargain, or I should not 
have bought them. The silver rims alone will sell 
for double the money." 

But it is an undeniable fact, that many persons of 



HOMOEOPATHY AND ITS KINDKED DELUSIONS. 23 

considerable standing, and in some instances holding 
the most elevated positions in society, openly patron- 
ized the new practice. In a translation of a work 
entitled " Experiments with the Metallic Tractors," 
originally published in Danish, thence rendered suc- 
cessively into German and English, Mr. Benjamin 
Perkins, who edited the English edition, has given a 
copious enumeration of the distinguished individuals, 
both in America and Europe, whose patronage he 
enjoyed. He goes so far as to signify that Royalty 
itself was to be included among the number. When 
the Perkinean Institution was founded, no less a 
person than Lord Rivers was elected President, and 
eleven other individuals of distinction, among them 
Governor Franklin, son of Dr. Franklin, figured as 
Vice-Presidents. Lord Henniker, a member of the 
Royal Society, who is spoken of as a man of judgment 
and talents, condescended to patronize the astonish- 
ing discovery, and at different times bought three 
pairs of Tractors. When the Tractors were intro- 
duced into Europe, a large number of testimonials 
accompanied them from various distinguished char- 
acters in America, the list of whom is given in the 
translation of the Danish work referred to as follows : 
"Those who have individually stated cases, or who 
have presented their names to the public as men who 
approved of this remedy, and acknowledged them- 
selves instrumental in circulating the Tractors, are 
fifty-six in number ; thirty-four of whom are phy- 
sicians and surgeons, and many of them of the first 
eminence, thirteen clergymen, most of whom are 
doctors of divinity, and connected with the literary 
institutions of America; among the remainder are 
two members of Congress, one professor of natural 



24 



MEDICAL ESSAYS. 



philosophy in a college, etc., etc." It seemed to be 
taken rather hardly by Mr. Perkins that the transla- 
tors of the work which he edited, in citing- the names 
of the advocates of the Metallic Practice, frequently 
omitted the honorary titles which should have been 
amiexed. The testimonials were obtained by the 
Danish writer, from a pamphlet published in Amer- 
ica, in which these titles were given in full. Thus 
one of these testimonials is from "John Tyler, Esq., 
a magistrate in the county of New London, and late 
Brigadier-General of the militia in that State." The 
"omission of the General's title " is the subject of 
complaint, as if this title were sufficient evidence 
of the commanding powers of one of the patrons 
of tractoration. A similar complaint is made when 
" Calvin Goddard, Esq., of Pkinfield, Attorney at 
Law, and a member of the Legislature of the State 
of Connecticut," is mentioned without his titular 
honors, and even on account of the omission of the 
proper official titles belonging to " Nathan Pierce, 
Esq., Governor and Manager of the Almshouse of 
Newburyport." These instances show the great im- 
portance to be attached to civil and military dignities, 
in qualifying their holders to judge of scientific sub- 
jects, a truth which has not been overlooked by the 
legitimate successors of the Perkinists. In Great 
Britain, the Tractors were not less honored than in 
America, by the learned and the illustrious. The 
"Perkinistie Committee" made this statement in 
their report : " Mr. Perkins has annually laid before 
the public a large collection of new cases communi- 
cated to him for that purpose by disinterested and 
intelligent characters, from almost every quarter of 
Great Britain. In regard to the competency of these 



HOMCEOPATHY AND ITS KINDRED DELUSIONS. 25 

vouchers, it will be sufficient simply to state that, 
amongst others whose names have been attached to 
their communications, are eight professors, in four 
different universities, twenty-one regular Physicians, 
nineteen Surgeons, thirty Clergymen, twelve of whom 
are Doctors of Divinity, and numerous other charac- 
ters of equal respectability." 

It cannot but excite our notice and surprise that 
the number of clergymen both in America and Great 
Britain who thrust forward their evidence on this 
medical topic was singularly large in proportion to 
that of the members of the medical profession. 
Whole pages are contributed by such worthies as 
the Rev. Dr. Trotter of Hans Place, the Rev. War- 
ing Willett, Chaplain to the Earl of Dun more, the 
Rev. Dr. Clarke, Chaplain to the Prince of Wales. 
The style of these theologico - medical communica- 
tions may be seen in the following from a divine 
who was also professor in one of the colleges of New 
England. "I have used the Tractors with success 
in several other cases in my own family, and al- 
though, like Naaman the Syrian, I cannot tell why 
the waters of Jordan should be better than Abana 
and Pharpar, rivers of Damascus ; yet since expe- 
rience has proved them so, no reasoning can change 
the opinion. Indeed, the causes of all common facts 
are, we think, perfectly well known to us ; and it is 
very probable, fifty or a hundred j^ears hence, we 
shall as well know why the Metallic Tractors should 
in a few minutes remove violent pains, as we now 
know why cantharides and opium will produce oppo- 
site effects, namely, we shall know very little about 
either excepting facts." Fifty or a hundred years 
hence ! if he could have looked forward forty years, 



26 



MEDICAL ESSAYS. 



he would have seen the descendants of the "Perkin- 
istic " philosophers swallowing infinitesimal globules, 
and knowing and caring as much about the Tractors 
as the people at Saratoga Springs do about the waters 
of Abana and Pharpar. 

I trust it will not be thought in any degree disre- 
spectful to a profession which we all honor, that I 
have mentioned the great zeal of many clergymen in 
the cause of Perkinism. I hope, too, that I may 
without offence suggest the causes which have often 
led them out of their own province into one to which 
their education has no special reference. The mem- 
bers of that profession ought to be, and commonly 
are, persons of benevolent character. Their duties 
carry them into the midst of families, and particu- 
larly at times when the members of them are suffer- 
ing from bodily illness. It is natural enough that a 
strong desire should be excited to alleviate sufferings 
which may have defied the efforts of professional 
skill ; as natural that any remedy which recommends 
itself to the belief or the fancy of the spiritual phy- 
sician should be applied with the hope of benefit; 
and perfectly certain that the weakness of human 
nature, from which no profession is exempt, will lead 
him to take the most flattering view of its effects 
upon the patient ; his own sagacity and judgment 
being staked upon the success of the trial. The in- 
ventor of the Tractors was aware of these truths. He 
therefore sent the Tractors gratuitously to many cler- 
gymen, accompanied with a formal certificate that 
the holder had become entitled to their possession 
by the payment of five guineas. This was practised 
in our own neighborhood, and I remember finding 
one of these certificates, so presented, which proved 



HOMCEOPATHY AND ITS KINDRED DELUSIONS. 2T 

that amongst the risks of infancy I had to encounter 
Perkins's Tractors. Two clergymen of Boston and 
the vicinit} 7- , both well known to local fame, gave in 
their testimony to the value of the instruments thus 
presented to them ; an unusually moderate proportion, 
when it is remembered that to the common motives 
of which I have spoken was added the seduction of a 
gift for which the profane public was expected to pay 
so largely. 

It was remarkable, also, that Perkinism, which had 
so little success with the medical and scientific part 
of the community, found great favor in the eyes of its 
more lovely and less obstinate portion. " The lady 
of Major Oxholm," — I quote from Mr. Perkins's 
volume, — " having been lately in America, had seen 
and heard much of the great effects of Perkinism. 
Influenced by a most benevolent disj)osition, she 
brought these Tractors and the pamphlet with her 
to Europe, with a laudable desire of extending their 
utility to her suffering countrymen." Such was the 
channel by which the Tractors were conveyed to Den- 
mark, where they soon became the ruling passion. 
The workmen, says a French writer, could not man- 
ufacture them fast enough. Women carried them 
about their persons, and delighted in bringing them 
into general use. To what extent the Tractors were 
favored with the patronage of English and American 
ladies, it is of course not easy to say, except on gen- 
eral principles, as their names were not brought be- 
fore the public. But one of Dr. Haygarth's stories 
may lead us to conjecture that there was a class of 
female practitioners who went about doing good with 
the Tractors in England as well as in Denmark. A 
certain lady had the misfortune to have a spot as big 



28 MEDICAL ESSAYS. 

as a silver penny at the corner of her eye, caused by 
a bruise, or some such injury. Another lady, who 
was a friend of hers, and a strong believer in Per- 
kinism, was very anxious to try the effects of trac- 
toration upon this unfortunate blemish. The patient 
consented ; the lady " produced the instruments, and, 
after drawing them four or five times over the spot, 
declared that it changed to a paler color, and on re- 
peating the use of them a few minutes longer, that 
it had almost vanished, and was scarcely visible, and 
departed in high triumph at her success." The lady 
who underwent the operation assured the narrator 
" that she looked in the glass immediately after, and 
that not the least visible alteration had taken place." 

It would be a very interesting question, what was 
the intellectual character of those persons most con- 
spicuous in behalf of the Perkinistic delusion ? Such 
an inquiry might bring to light some principles 
which we could hereafter apply to the study of other 
popular errors. But the obscurity into which nearly 
all these enthusiasts have subsided renders the ques- 
tion easier to ask than to answer. I believe it would 
have been found that most of these persons were of 
ardent temperament and of considerable imagination, 
and that their history would show that Perkinism was 
not the first nor the last hobby-horse they rode fu- 
riously. Many of them may very probably have been 
persons of more than common talent, of active and in- 
genious minds, of versatile powers and various acquire- 
ments. Such, for instance, was the estimable man to 
whom I have repeatedly referred as a warm defender 
of tractoration, and a bitter assailant of its enemies. 
The story tells itself in the biographical preface to his 
poem. He went to London with the view of introdu- 



HOMOEOPATHY AND ITS KINDRED DELUSIONS. 29 

cing a hydraulic machine, which he and his Vermont 
friends regarded as a very important invention. He 
found, however, that the machine was already in com- 
mon use in that metropolis. A brother Yankee, then 
in London, had started the project of a mill, which 
was to be carried by the water of the Thames. He 
was sanguine enough to purchase one fifth of this con- 
cern, which also proved a failure. At about the same 
period he wrote the work which proved the great ex- 
citement of his mind upon the subject of the transient 
folly then before the public. Originally a lawyer, he 
was in succession a mechanician, a poet, and an editor, 
meeting with far less success in each of these depart- 
ments than usually attends men of less varied gifts, 
but of more tranquil and phlegmatic composition. 
But who is ignorant that there is a class of minds 
characterized by qualities like those I have mentioned ; 
minds with many bright and even beautiful traits ; but 
aimless and fickle as the butterfly ; that settle upon 
every gayly-colored illusion as it opens into flower, and 
flutter away to another when the first has dropped its 
leaves, and stands naked in the icy air of truth ! 

Let us now look at the general tenor of the argu- 
ments addressed by believers to sceptics and opponents. 
Foremost of all, emblazoned at the head of every col- 
umn, loudest shouted by every triumphant disputant, 
held up as paramount to all other considerations, 
stretched like an impenetrable shield to protect the 
weakest advocate of the great cause against the weap- 
ons of the adversary, was that omnipotent monosylla- 
ble which has been the patrimony of cheats and the 
currency of dupes from time immemorial, — Facts ! 
Facts ! Facts ! First came the published cases of the 
American clergymen, brigadier - generals, almshouse 



30 



MEDICAL ESSAYS. 



governors, representatives, attorneys, and esquires. 
Then came the published cases of the surgeons of 
Copenhagen. Then followed reports of about one hun- 
dred and fifty cases published in England, " demon- 
strating the efficacy of the metallic practice in a va- 
riety of complaints both upon the human body and on 
horses, etc." But the progress of facts in Great Brit- 
ain did not stop here. Let those who rely upon the 
numbers of their testimonials, as being alone sufficient 
to prove the soundness and stability of a medical nov- 
elty, digest the following from the report of the Per- 
kinistic Committee. " The cases published [in Great 
Britain] amounted, in March last, the date of Mr. Per- 
kins's last publication, to about five thousand. Sup- 
posing that not more than one cure in three hundred 
which the Tractors have performed lias been published, 
and the proportion is probably much greater, it will 
be seen that the number, to March last, will have ex- 
ceeded one million five hundred thousand ! " 

Next in order after the appeal to what were called 
facts, came a series of arguments, which have been so 
long bruised and battered round in the cause of every 
doctrine or pretension, new, monstrous, or deliriously 
impossible, that each of them is as odiously familiar 
to the scientific scholar as the faces of so many old 
acquaintances, among the less reputable classes, to the 
officers of police. 

No doubt many of my hearers will recognize, in the 
following passages, arguments they may have heard 
brought forward with triumphant confidence in behalf 
of some doctrine not yet extinct. No doubt some may 
have honestly thought they proved something; may 
have used them with the purpose of convincing their 
friends, or of silencing the opponents of their favorite 



HOMCEOPATHY AND ITS KINDRED DELUSIONS. 31 

doctrine, whatever that might be. But any train of 
arguments which was contrived for Perkinism, which 
was just as applicable to it as to any other new doctrine 
in the same branch of science, and which was fully 
employed against its adversaries forty years since, 
might, in common charity, be suffered to slumber in 
the grave of Perkinism. Whether or not the follow- 
ing sentences, taken literally from the work of Mr. 
Perkins, were the originals of some of the idle propo- 
sitions we hear bandied about from time to time, let 
those who listen judge. 

The following is the test assumed for the new prac- 
tice : " If diseases are really removed, as those persons 
who have practised extensively with the Tractors de- 
clare, it should seem there would be but little doubt of 
their being generally adopted ; but if the numerous 
reports of their efficacy which have been published are 
forgeries, or are unfounded, the practice ought to be 
crushed." To this I merely add, it has been crushed. 

The following sentence applies to that a priori 
judging and uncandid class of individuals who buy 
their dinners without tasting all the food there is in 
the market. " On all discoveries there are persons who, 
without descending to any inquiry into the truth, pre- 
tend to know, as it were by intuition, that newly as- 
serted facts are founded in the grossest errors. These 
were those who kneiv that Harvey's report of the cir- 
culation of the blood was a preposterous and ridiculous 
suggestion, and in latter [later] days there were others 
who kneAV that Franklin deserved reproach for declar- 
ing that points were preferable to balls for protecting 
buildings from lightning." 

Again: " This unwarrantable mode of offering as- 
sertion for proof, so unauthorized and even unprece- 



32 MEDICAL ESSAYS. 

dented except in the condemnation of a Galileo, the 
persecution of a Copernicus, and a few other acts of 
inquisitorial authority, in the times of ignorance and 
superstition, affords but a lamentable instance of one 
of his remarks, that this is far from being 1 the Age of 
Reason." 

" The most valuable medicines in the Materia Med- 
ica act on principles of which we are totally ignorant. 
None have ever yet been able to explain how opium 
produces sleep, or how bark cures intermittent fevers ; 
and yet few, it is hoped, will be so absurd as to desist 
from the vise of these important articles because they 
know nothing of the principle of their operations." Or 
if the argument is preferred, in the eloquent language 
of the Perkinistic poet : — 

" What though the causes may not be explained, 
Since these KFFECTS are duly ascertained, 
Let not self-interest, prejudice, or pride, 
Induce mankind to set the means aside ; 
Means which, though simple, are by Heaven designed 
T' alleviate the woes of human kind." 

This course of argument is so often employed, 
that it deserves to be expanded a little, so that its 
length and breadth may be fairly seen. A series of 
what are called facts is brought forward to prove 
some very improbable doctrine. It is objected by ju- 
dicious people, or such as have devoted themselves to 
analogous subjects, that these assumed facts are in 
direct opposition to all that is known of the course of 
nature, that the universal experience of the past af- 
fords a powerful presumption against their truth, and 
that in proportion to the gravity of these objections, 
should be the number and competence of the witnesses. 
The answer is a ready one. What do we know of the 



HOMCEOPATHT AND ITS KINDRED DELUSIONS. 33 

mysteries of Nature ? Do we understand the intricate 
machinery of the Universe ? When to this is added 
the never-failing quotation, — 

" There are more things in heaven and earth, Horatio, 
Than are dreamt of in your philosophy," — 

the question is thought to be finally disposed of. 

Take the case of astrology as an example. It is in 
itself strange and incredible that the relations of the 
heavenly bodies to each other at a given moment of 
time, perhaps half a century ago, should have any- 
thing to do with my success or misfortune in any 
undertaking of to-day. But what right have I to say 
it cannot be so ? Can I bind the sweet influences of 
Pleiades, or loose the bands of Orion ? I do not know 
by what mighty magic the planets roll in their fluid 
paths, confined to circles as unchanging as if they were 
rings of steel, nor why the great wave of ocean fol- 
lows in a sleepless round upon the skirts of moonlight ; 
nor can I say from any certain knowledge that the 
phases of the heavenly bodies, or even the falling of 
the leaves of the forest, or the manner in which the 
sands lie upon the sea-shore, may not be knit up by 
invisible threads with the web of human destiny. 
There is a class of minds much more ready to believe 
that which is at first sight incredible, and because it 
is incredible, than what is generally thought reason- 
able. Credo quia impossibile est, — "I believe, be- 
cause it is impossible," — is an old paradoxical expres- 
sion which might be literally applied to this tribe of 
persons. Jind they always succeed in finding some- 
thing marvellous, to call out the exercise of their ro- 
bust faith. The old Cabalistic teachers maintained 
that there was not a verse, line, word, or even letter 
in the Bible which had not a special efficacy either to 



34 MEDICAL ESSAYS. 

defend the person who rightly employed it, or to injure 
his enemies ; always provided the original Hebrew was 
made use of. In the hands of modern Cabalists every 
substance, no matter how inert, acquires wonderful 
medicinal virtues, provided it be used in a proper state 
of purity and subdivision. 

I have already mentioned the motives attributed by 
the Perkinists to the Medical Profession, as prevent- 
ing its members from receiving the new but unwel- 
come truths. This accusation is repeated in different 
forms and places, as, for instance, in the following pas- 
sage : — 

" Will the medical man who has spent much money 
and labor in the pursuit of the arcana of Physic, and 
on the exercise of which depends his support in life, 
proclaim the inefficacy of his art, and recommend a 
remedy to his patient which the most unlettered in 
society can employ as advantageously as himself ? 
and a remedy, too, which, unlike the drops, the pills, 
the powders, etc., of the Materia Medica, is inconsum- 
able, and ever in readiness to be employed in success- 
ive diseases ? " 

As usual with these people, much indignation was 
expressed at any parallel between their particular doc- 
trine and practice and those of their exploded prede- 
cessors. "The motives," says the disinterested Mr. 
Perkins, " which must have impelled to this attempt 
at classing the Metallic Practice with the most 
paltry of empyrical projects, are but too thinly /eiled 
to escape detection." 

To all these arguments was added, as a matter of 
course, an appeal to the feelings of the benevolent in 
behalf of suffering humanity, in the shape of a notice 
that the poor would be treated gratis. It is pretty 



HOMOEOPATHY AND ITS KINDRED DELUSIONS. 35 

well understood that this gratuitous treatment of the 
poor does not necessarily imply an excess of benevo- 
lence, any more than the gratuitous distribution of a 
trader's shop-bills is an evidence of remarkable gen- 
erosity ; in short, that it is one of those things which 
honest men often do from the best motives, but which 
rogues and impostors never fail to announce as one 
of their special recommendations. It is astonishing to 
see how these things brighten up at the touch of Mr. 
Perkins's poet : — 

"Ye worthy, honored, philanthropic few. 

The muse shall weave her brightest wreaths for you, 

Who in Humanity's bland cause unite, 

!Nor heed the shaft by interest aimed or spite ; 

Like the great Pattern of Benevolence, 

Hygeia's blessings to the poor dispense; 

And though opposed by folly's servile brood, 

EXJOY THE LUXURY OF DOING GOOD." 

Having thus sketched the history of Perkinism in 
its days of prosperity ; having seen how it sprung into 
being, and by what means it maintained its influence, 
it only remains to tell the brief story of its discom- 
fiture and final downfall. The vast majority of the 
sensible part of the medical profession were contented, 
so far as we can judge, to let it die out of itself. It 
was in vain that the advocates of this invaluable dis- 
covery exclaimed over their perverse and interested ob- 
stinacy, — in vain that they called up the injured 
ghosts of Harvey, Galileo, and Copernicus to shame 
that unbelieving generation ; the Baillies and the Heb- 
erdens, — men whose names have come down to us 
as synonymous with honor and wisdom, — bore their 
reproaches in meek silence, and left them unanswered 
to their fate. There were some others, however, who, 



s 

36 MEDICAL ESSAYS. 

believing the public to labor under a delusion, thought 
it worth while to see whether the charm would & be 
broken by an open trial of its virtue, as compared 
with that of some less haUowed formula. It must be 
remembered that a peculiar value was attached to the 
Metallic Tractors, as made and patented by Mr. Per- 
kins. Dr. Ilaygarth, of Bath, performed various 
experiments upon patients afflicted with different com- 
plaints, — the patients supposing that the real five- 
guinea Tractors were employed. Strange to relate, 
he obtained equally wonderful effects with Tractors of 
lead and of wood; with nails, pieces of bone, slate 
pencil, and tobacco-pipe. Dr. Alderson employed 
sham Tractors made of wood, and produced such ef- 
fects upon five patients that they returned solemn 
thanks in church for their cures. A single specimen 
of these cases may stand for all of them. Ann Hill 
had suffered for some months from pain in the right 
arm and shoulder. The Tractors (icoodoi ones) were 
applied, and in the space of five minutes she expressed 
herself relieved in the following apostrophe: "Bless 
me ! why, who could have thought it, that them little 
things could pull the pain from one. Well, to be sure, 
the longer one lives, the more one sees ; ah, dear \ " 

These experiments did not result in the immediate 
extinction of Perkinism. Doubtless they were a great 
comfort to many obstinate unbelievers, and helped to 
settle some sceptical minds ; but for the real Perkinis- 
tic enthusiasts, it may be questioned whether they 
would at that time have changed their opinion though 
one had risen from the dead to assure them that it was 
an error. It perished without violence, by an easy and 
natural process. Like the famous toy of Mongolfier, 
it rose by means of heated air, — the fevered breath of 



HOMCEOPATHT AND ITS KINDRED DELUSIONS. 37 

enthusiastic ignorance, — and when this grew cool, as 
it always does in a little while, it collapsed and fell. 

And now, on reviewing the whole subject, how shall 
we account for the extraordinary prevalence of the be- 
lief in Perkinism among a portion of what is supposed 
to be the thinking part of the community ? 

Could the cures have been real ones, produced by 
the principle of Animal Magnetism ? To this it may 
be answered that the Perkinists ridiculed the idea of 
approximating Mesmer and the founder of their own 
doctrine, that nothing like the somnambulic condition 
seems to have followed the use of the Tractors, and 
that neither the exertion of the will nor the powers of 
the individual who operated seem to have been consid- 
ered of any consequence. Besides, the absolute neglect 
into which the Tractors soon declined is good evidence 
that they were incapable of affording any considerable 
and permanent relief in the complaints for the cure of 
which they were applied. 

Of course a large number of apparent cures were 
due solely to nature ; which is true under every form 
of treatment, orthodox or empirical. Of course many 
persons experienced at least temporary relief from the 
strong impression made upon their minds by this novel 
and marvellous method of treatment. 

Many, again, influenced by the sanguine hopes of 
those about them, like dying people, who often say 
sincerely, from day to day, that they are getting bet- 
ter, cheated themselves into a false and short-lived be- 
lief that they were cured ; and as happens in such 
cases, the public never knew more than the first half 
of the story. 

When it was said to the Perkinists, that whatever 



38 MEDICAL ESSAYS. 

effects they produced were merely through the imagi- 
nation, they declared (like the advocates of the Royal 
Touch and the Unguentum Armarium) that this 
explanation was sufficiently disproved by the fact of 
numerous and successful cures which had been wit- 
nessed in infants and brute animals. Dr. Haygarth 
replied to this, that " in these cases it is not the Pa- 
tient, but the Observer, who is deceived by his own 
imagination," and that such may be the fact, we have 
seen in the case of the good lady who thought she had 
conjured away the spot from her friend's countenance, 
when it remained just as before. 

As to the motives of the inventor and vender of the 
Tractors, the facts must be allowed to speak for them- 
selves. But when two little bits of brass and iron are 
patented, as an invention, as the result of numerous 
experiments, when people are led, or even allowed, to 
infer that they are a peculiar compound, when they are 
artfully associated with a new and brilliant discovery 
(which then happened to be Galvanism), when they 
are sold at many hundred times their value, and the 
seller prints his opinion that a Hospital will suffer in- 
convenience "unless it possesses many sets of the 
Tractors, and these placed in the hands of the patients 
to practise on each other," one cannot but suspect that 
they were contrived in the neighborhood of a wooden 
nutmeg factory ; that legs of ham in that region are 
not made of the best mahogany ; and that such as buy 
their cucumber seed in that vicinity have to wait for 
the fruit as long as the Indians for their crop of gun- 
powder. 

The succeeding lecture will be devoted to an exam- 
ination of the doctrines of Samuel Hahnemann and 



HOMOEOPATHY AND ITS KINDRED DELUSIONS. 39 

his disciples ; doctrines which some consider new and 
others old ; the common title of which is variously 
known as H6-mceopathy, Homoe-6p-athy, Homceo-path-y, 
or Hom'pathy, and the claims of which are considered 
by some as infinitely important, and by many as im- 
measurably ridiculous. 

I wish to state, for the sake of any who may be in- 
terested in the subject, that I shall treat it, not by 
ridicule, but by argument ; perhaps with great free- 
dom, but with good temper and in peaceable language ; 
with very little hope of reclaiming converts, with no 
desire of making enemies, but with a firm belief that 
its pretensions and assertions cannot stand before a 
single hour of calm investigation. 



II. 

It may be thought that a direct attack upon the 
pretensions of Homoeopathy is an uncalled-for aggres- 
sion upon an unoffending doctrine and its peaceful 
advocates. 

But a little inquiry will show that it has long as- 
sumed so hostile a position with respect to the Medical 
Profession, that any trouble I, or any other member of 
that profession, may choose to bestow upon it may be 
considered merely as a matter of self-defence. It began 
with an attempt to show the insignificance of all existing 
medical knowledge. It not only laid claim to wonder- 
ful powers of its own, but it declared the common 
practice to be attended with the most positively inju- 
rious effects, that by it acute diseases are aggravated, 
and chronic diseases rendered incurable. It has at 
various times brought forward collections of figures 



40 MEDICAL ESSAYS. 

having the air of statistical documents, pretending to 
show a great proportional mortality among the patients 
of the Medical Profession, as compared with those 
treated according to its own rules. Not contented 
with choosing a name of classical origin for itself, it 
invented one for the whole community of innocent 
physicians, assuring them, to their great surprise, that 
they were all Allopath ists, whether they knew it or 
not, and including all the illustrious masters of the 
past, from Hippocrates down to Hunter, under the 
same gratuitous title. The line, then, has been drawn 
by the champions of the new doctrine ; they have lifted 
the lance, they have sounded the charge, and are re- 
sponsible for any little skirmishing which may happen. 

But, independently of any such grounds of active 
resistance, the subject involves interests so dispropor- 
tioned to its intrinsic claims, that it is no more than 
an act of humanity to give it a public examination. If 
the new doctrine is not truth, it is a dangerous, a 
deadly error. If it is a mere illusion, and acquires the 
same degree of influence that we have often seen ob- 
tained by other illusions, there is not one of my 
audience who may not have occasion to deplore the 
fatal credulity which listened to its promises. 

I shall therefore undertake a sober examination of 
its principles, its facts, and some" points of its history. 
The limited time at my disposal requires me to con- 
dense as much as possible what I have to say, but I 
shall endeavor to be plain and direct in expressing it. 
Not one statement shall be made which cannot be sup- 
ported by unimpeachable reference : not one word 
shall be uttered which I am not as willing to print as 
to speak. I have no quibbles to utter, and I shall 
stoop to answer none ; but, with full faith in the suffi- 



HOMOEOPATHY AND ITS KINDRED DELUSIONS. 41 

ciency of a plain statement of facts and reasons, I sub- 
mit the subject to the discernment of my audience. 

The question may be asked in the outset, — Have 
you submitted the doctrines you are professing to 
examine to the test of long-repeated and careful ex- 
periment ; have you tried to see whether they were 
true or not ? To this I answer, that it is abundantly 
evident, from what has often happened, that it would 
be of no manner of use for me to allege the results of 
any experiments I might have instituted. Again and 
again have the most explicit statements been made by 
the most competent persons of the utter failure of all 
their trials, and there were the same abundant explana- 
tions offered as used to be for the Unguentum Arma- 
rium and the Metallic Tractors. I could by no possibil- 
ity perform any experiments the result of which coidd 
not be easily explained away so as to be of no conclu- 
sive significance. Besides, as arguments in favor of 
Homoeopathy are constantly addressed to the public in 
journals, pamphlets, and even lectures, by inexperienced 
dilettanti, the same channel must be open to all its 
opponents. 

It is necessary, for the sake of those to whom the 
whole subject may be new, to give in the smallest 
possible compass the substance of the Homoeopathic 
Doctrine. Samuel Hahnemann, its founder, is a 
German physician, now living in Paris," at the age of 
eighty-seven years. In 1796 he published the first 
paper containing his peculiar notions ; in 1805 his 
first work on the subject ; in 1810 his somewhat 
famous " Organon of the Healing Art ; " the next year 
what he called the " Pure Materia Medica ; ? ' and in 
a Hahnemann died in 1843. 



42 



MEDICAL ESSAYS. 



1828 his last work, the "Treatise on Chronic Dis- 
eases." He has therefore been writing at intervals on 
his favorite subject for nearly half a century. 

The one great doctrine which constitutes the basis 
of Homoeopathy as a system is expressed by the Latin 
aphorism, 

"SlMILIA SIMILIBUS CURANTUR," 

or like cures like, that is, diseases are cured by agents 
capable of producing symptoms resembling those 
found in the disease under treatment. A disease for 
Hahnemann consists essentially in a group of symp- 
toms. The proper medicine for any disease is the one 
which is capable of producing a similar group of symp- 
toms when given to a healthy person. 

It is of course necessary to know what are the 
trains of symptoms excited by different substances, 
when administered to persons in health, if any such 
can be shown to exist. Hahnemann and his disciples 
give catalogues of the symptoms which they affirm 
were produced upon themselves or others by a large 
number of drugs which they submitted to experi- 
ment. 

The second great fact which Hahnemann professes 
to have established is the efficacy of medicinal sub- 
stances reduced to a wonderful degree of minuteness 
or dilution. The following account of his mode of 
preparing his medicines is from his work on Chronic 
Diseases, which has not, I believe, yet been translated 
into English. A grain of the substance, if it is solid, 
a drop if it is liquid, is to be added to about a third 
part of one hundred grains of sugar of milk in an 
unglazed porcelain capsule which has had the polish 
removed from the lower part of its cavity by rubbing 



HOMCEOPATHY AND ITS KINDRED DELUSIONS. 43 

it with wet sand ; they are to be mingled for an in- 
stant with a bone or horn spatula, and then rubbed 
together for six minutes ; then the mass is to be 
scraped together from the mortar and pestle, which 
is to take four minutes ; then to be again rubbed for 
six minutes. Four minutes are then to be devoted 
to scraping the powder into a heap, and the second 
third of the hundred grains of sugar of milk to be 
added. Then they are to be stirred an instant and 
rubbed six minutes, — again to be scraped together 
four minutes and forcibly rubbed six; once more 
scraped together for four minutes, when the last 
third of the hundred grains of sugar of milk is to 
be added and mingled by stirring with the spatula ; 
six minutes of forcible rubbing, four of scraping to- 
gether, and six more (positively the last six) of rub- 
bing, finish this part of the process. 

Every grain of this powder contains the hundredth 
of a grain of the medicinal substance mingled with 
the sugar of milk. If, therefore, a grain of the pow- 
der just prepared is mingled with another hundred 
grains of sugar of milk, and the process just described 
repeated, we shall have a powder of which every 
grain contains the hundredth of the hundredth, or 
the ten thousandth part of a grain of the medicinal 
substance. Repeat the same process with the same 
quantity of fresh sugar of milk, and every grain of 
your powder will contain the millionth of a grain of 
the medicinal substance. When the powder is of this 
strength, it is ready to employ in the further solutions 
and dilutions to be made use of in practice. 

A grain of the powder is to be taken, a hundred 
drops of alcohol are to be poured on it, the vial is to 
be slowly turned for a few minutes, until the powder 



44 MEDICAL ESSAYS. 

is dissolved, and two shakes are to be given to it. On 
this point I will quote Hahnemann's own words. " A 
long experience and multiplied observations upon the 
sick lead me within the last few years to prefer giving 
only two shakes to medicinal liquids, whereas I for- 
merly used to give ten." The process of dilution is 
carried on in the same way as the attenuation of the 
powder was done ; each successive dilution with alco- 
hol reducing the medicine to a hundredth part of the 
quantity of that which preceded it. In this way the 
dilution of the original millionth of a grain of medi- 
cine contained in the grain of powder operated on is 
carried successively to the billionth, trillionth, quad- 
rillionth, quintillionth, and very often much higher 
fractional divisions. A dose of any of these medi- 
cines is a minute fraction of a drop, obtained by 
moistening with them one or more little globules of 
sugar, of which Hahnemann says it takes about two 
hundred to weigh a grain. 

As an instance of the strength of the medicines 
prescribed by Hahnemann, I will mention carbonate 
of lime. He does not employ common chalk, but pre- 
fers a little portion of the friable part of an oyster- 
shell. Of this substance, carried to the sextillionth 
degree, so much as one or two globules of the size 
mentioned can convey is a common dose. But for 
persons of very delicate nerves it is proper that the 
dilution should be carried to the decillionth degree. 
That is, an important medicinal effect is to be ex- 
pected from the two hundredth or hundredth part of 
the millionth of the millionth of the millionth of the 
millionth of the millionth of the millionth of the 
millionth of the millionth of the millionth of the 
millionth of a grain of oyster-shell. This is only the 



HOMCEOPATHY AND ITS KINDRED DELUSIONS. 45 

tenth degree of potency, but some of his disciples pro- 
fess to have obtained palpable effects from much higher 
dilutions." 

The third great doctrine of Hahnemann is the fol- 
lowing. Seven eighths at least of all chronic diseases 
are produced by the existence in the system of that in- 
fectious disorder known in the language of science by 
the appellation of Psora, but to the less refined por- 
tion of the community by the name of Itch. In the 
words of Hahnemann's "Organon," " This Psora is the 
sole true and fundamental cause that produces all the 
other countless forms of disease, which, under the 
names of nervous debility, hysteria, hypochondriasis, 
insanity, melancholy, idiocy, madness, epilepsy, and 
spasms of all kinds, softening of the bones, or rickets, 
scoliosis and cyphosis, caries, cancer, fungus nema- 
todes, gout, — yellow jaundice and cyanosis, dropsy, — 

a The degrees of dilution must not be confounded with 
those of potency. Their relations may be seen by this 
table : — 

One hundredth of a drop or grain. 

One ten thousandth. 

One millionth, — marked I. 

One hundred millionth. 

One ten thousand millionth. 

One million millionth, or one billionth, — 

marked II. 
One hundred billionth. 
One ten thousand billionth. 
One million billionth, or one trillionth, — 

marked III. 
One hundred trillionth. 
One ten thousand trillionth. 
One million trillionth, or one qnadrillionth, — ■ 

marked IV., — and so on indefinitely. 

The large figures denote the degrees of potency. 



1st di 


iution 


2d 


tt 


3d 


a 


4 th 


u 


5 th 


(i 


6 th 


tt 


7th 


a 


8 th 


H 


9th 


it 


10 th 


u 


11th 


it 


12th 


it 



46 MEDICAL ESSAYS. 

gastralgia, epistaxis, haemoptysis, — asthma and sup- 
puration of the lungs, — megrim, deafness, cataract 
and amaurosis, — paralysis, loss of sense, pains of 
every kind, etc., appear in our pathology as so many 
peculiar, distinct, and independent diseases." 

For the last three centuries, if the same authority 
may be trusted, under the influence of the more re- 
fined personal habits which have prevailed, and the 
application of various external remedies which repel 
the affection from the skin, Psora has revealed itself 
in these numerous forms of internal disease, instead of 
appearing, as in former periods, under the aspect of 
an external malady. 

These are the three cardinal doctrines of Hahne- 
mann, as laid down in those standard works of Ho- 
moeopathy, the " Organon " and the " Treatise on 
Chronic Diseases." 

Several other principles may be added, upon all of 
which he insists with great force, and which are very 
generally received by his disciples. 

1. Very little power is allowed to the curative ef- 
forts of nature. Hahnemann goes so far as to say 
that no one has ever seen the simple efforts of nature 
effect the durable recovery of a patient from a chronic 
disease. In general, the Homceopathist calls every re- 
covery which happens under his treatment a cure. 

2. Every medicinal substance must be administered 
in a state of the most perfect purity, and uncombined 
with any other. The union of several remedies in a 
single prescription destroys its utility, and, according 
to the " Organon," frequently adds a new disease. 

3. A large number of substances commonly thought 
to be inert develop great medicinal powers when pre- 
pared in the manner already described ; and a great 



HOMOEOPATHY AND ITS KINDRED DELUSIONS. 47 

proportion of them are ascertained to have specific an- 
tidotes in case their excessive effects require to be neu- 
tralized. 

4. Diseases should be recognized, as far as possible, 
not by any of the common names imposed upon them, 
as fever or epilepsy, but as individual collections of 
symptoms, each of which differs from every other col- 
lection. 

5. The symptoms of any complaint must be de- 
scribed with the most minute exactness, and so far as 
possible in the patient's own words. To illustrate the 
kind of circumstances the patient is expected to record, 
I will mention one or two from the 313th page of the 
"Treatise on Chronic Diseases," — being the first one 
at which I opened accidentally. 

"After dinner, disposition to sleep; the patient 
winks." 

" After dinner, prostration and feeling of weakness 
(nine days after taking the remedy)." 

This remedy was that same oyster-shell which is to 
be prescribed in fractions of the sextillionth or decil- 
lionth degree. According to Hahnemann, the action 
of a single dose of the size mentioned does not fully 
display itself in some cases until twenty-four or even 
thirty days after it is taken, and in such instances has 
not exhausted its good effects until towards the for- 
tieth or fiftieth day, — before which time it would be 
absurd and injurious to administer a new remedy. 

So much for the doctrines of Hahnemann, which 
have been stated without comment, or exaggeration of 
any of their features, very much as any adherent of 
his opinions might have stated them, if obliged to 
compress them into so narrow a space. 



48 MEDICAL ESSAYS. 

Does Hahnemann himself represent Homoeopathy 
as it now exists ? He certainly ought to be its best 
representative, after having created it, and devoted his 
life to it for half a century. He is spoken of as the 
great physician of the time, in most, if not all Homoe- 
opathic works. If he is not authority on the subject 
of his own doctrines, who is t So far as I am aware, 
not one tangible discovery in the so-called science has 
ever been ascribed to any other observer ; at least, no 
general principle or law, of consequence enough to 
claim any prominence in Homoeopathic works, has ever 
been pretended to have originated with any of his il- 
lustrious disciples. He is one of the only two Homoe- 
opathic writers with whom, as I shall mention, the 
Paris publisher will have anything to do upon his own 
account. The other is Jahr, whose Manual is little 
more than a catalogue of symptoms and remedies. If 
any persons choose to reject Hahnemann as not in the 
main representing Homoeopathy, if they strike at his 
authority, if they wink out of sight his deliberate and 
formally announced results, it is an act of suicidal 
rashness ; for upon his sagacity and powers of obser- 
vation, and experience, as embodied in his works, and 
especially in his Materia Medica, repose the founda- 
tions of Homoeopathy as a practical system. 

So far as I can learn from the conflicting statements 
made upon the subject, the following is the present 
condition of belief. 

1. All of any note agree that the law Similia si- 
milibus is the only fundamental principle in medicine. 
Of course if any man does not agree to this the name 
Homoeopathist can no longer be applied to him with 
propriety. 

2. The belief in and employment of the infinitesi- 



HOMCEOPATHY AND ITS KINDRED DELUSIONS. 49 

mal closes is general, and in some places universal, 
among the advocates of Homoeopathy ; but a distinct 
movement has been made in Germany to get rid of 
any restriction to the use of these doses, and to em- 
ploy medicines with the same license as other prac- 
titioners. 

3. The doctrine of the origin of most chronic dis- 
eases in Psora, notwithstanding Hahnemann says it 
cost him twelve years of study and research to estab- 
lish the fact and its practical consequences, has met 
with great neglect and even opposition from very many 
of his own disciples. 

It is true, notwithstanding, that, throughout most of 
their writings which I have seen, there runs a prevail- 
ing tone of great deference to Hahnemann's opinions, 
a constant reference to his authority, a general agree- 
ment with the minor points of his belief, and a pre- 
tence of harmonious union in a common f aith. a 

Many persons, and most physicians and scientific 
men, would be satisfied with the statement of these 
doctrines, and examine them no further. They would 
consider it vastly more probable that any observer in 
so fallacious and difficult a field of inquiry as medicine 
had been led into error, or walked into it of his own 
accord, than that such numerous and extraordinary 
facts had really just come to light. They would feel 
a right to exercise the same obduracy towards them as 
the French Institute is in the habit of displaying when 
memoirs or models are offered to it relating to the 
squaring of the circle or perpetual motion ; which it is 

° Those who will take the trouble to look over Hull's Trans- 
lation of Jahr's Manual may observe how little comparative 
space is given to remedies resting upon any other authority than 
that of Hahnemann. 
4 



50 MEDICAL ESSAYS. 

the rule to pass over without notice. They would feel 
as astronomers and natural philosophers must have felt 
when, some half a dozen years ago, an unknown man 
came forward, and asked for an opportunity to demon- 
strate to Arago and his colleagues that the moon and 
planets were at a distance of a little more than a hun- 
dred miles from the earth. And so they would not 
even look into Homoeopathy, though all its advocates 
should exclaim in the words of Mr. Benjamin Doug- 
lass Perkins, vender of the Metallic Tractors, that u On 
all discoveries there are persons who, without descend- 
ing to any inquiry into the truth, pretend to know, as 
it were by intuition, that newly asserted facts are 
founded in the grossest errors." And they would lay 
their heads upon their pillows with a perfectly clear 
conscience, although they were assured that they were 
behaving in the same way that people of old did to- 
wards Harvey, Galileo, and Copernicus, the identical 
great names which were invoked by Mr. Benjamin 
Douglass Perkins. 

But experience has shown that the character of 
these assertions is not sufficient to deter many from 
examining their claims to belief. I therefore lean but 
very slightly on the extravagance and extreme appar- 
ent singularity of their pretensions. I might have 
omitted them, but on the whole it seemed more just 
to the claims of my argument to suggest the vast com- 
plication of improbabilities involved in the statements 
enumerated. Every one must of course judge for 
himself as to the weight of these objections, which are 
by no means brought forward as a proof of the ex- 
travagance of Homoeopathy, but simply as entitled to 
a brief consideration before the facts of the case are 
submitted to our scrutiny. 



HOMOEOPATHY AND ITS KINDRED DELUSIONS. 51 

The three great asserted discoveries of Hahnemann 
are entirely unconnected with and independent of each 
other. Were there any natural relation between them 
it would seem probable enough that the discovery of 
the first would have led to that of the others. But 
assuming it to be a fact that diseases are cured by 
remedies capable of producing symptoms like their 
own, no manifest relation exists between this fact and 
the next assertion, namely, the power of the infinite s- 
imal doses. And allowing both these to be true, 
neither has the remotest affinity to the third new doc- 
trine, that which declares seven eighths of all chronic 
diseases to be owing to Psora. 

This want of any obvious relation between Hahne- 
mann's three cardinal doctrines appears to be self- 
evident upon inspection. But if, as is often true with 
his disciples, they prefer the authority of one of 
their own number, I will refer them to Dr. Trinks's 
paper on the present state of Homoeopathy in Europe, 
with which, of course, they are familiar, as his name 
is mentioned as one of the most prominent champions 
of their faith, in their American official organ. It 
would be a fact without a parallel in the history, not 
merely of medicine, but of science, that three such 
unconnected and astonishing discoveries, each of them 
a complete revolution of all that ages of the most va- 
ried experience had been taught to believe, should 
spring full formed from the brain of a single indi- 
vidual. 

Let us look a moment at the first of his doctrines. 
Improbable though it may seem to some, there is no 
essential absurdity involved in the proposition that 
diseases yield to remedies capable of producing like 
symptoms. There are, on the other hand, some anal- 



52 MEDICAL ESSAYS. 

ogies which lend a degree of plausibility to the state- 
ment. There are well-ascertained facts, known from 
the earliest periods of medicine, showing that, under 
certain circumstances, the very medicine which, from 
its known effects, one would expect to aggravate the 
disease, may contribute to its relief. I may be per- 
mitted to allude, in the most general way, to the case 
in which the spontaneous efforts of an overtasked 
stomach are quieted by the agency of a drug which 
that organ refuses to entertain upon any terms. But 
that every cure ever performed b}^ medicine should 
have been founded upon this principle, although with- 
out the knowledge of a physician ; that the Homoeo- 
pathic axiom is, as Hahnemann asserts, "the sole law 
of nature in therapeutics," a law of which nothing 
more than a transient glimpse ever presented itself to 
the innumerable host of medical observers, is a dogma 
of such sweeping extent, and pregnant novelty, that it 
demands a corresponding breadth and depth of un- 
questionable facts to cover its vast pretensions. 

So much ridicule has been thrown upon the pre- 
tended powers of the minute doses that I shall only 
touch upon this point for the purpose of conveying, 
by illustrations, some shadow of ideas far transcending 
the powers of the imagination to realize. It must be 
remembered that these comparisons are not matters 
susceptible of dispute, being founded on simple arith- 
metical computations, level to the capacity of any in- 
telligent schoolboy. A person who once wrote a very 
small pamphlet made some show of objecting to cal- 
culations of this kind, on the ground that the highest 
dilutions could easily be made with a few ounces of al- 
cohol. But he should have remembered that at every 
successive dilution he lays aside or throws away ninety- 



HOMCEOPATHY AND ITS KINDRED DELUSIONS. 53 

nine hundredths of the fluid on which he is operat- 
ing, and that, although he begins with a drop, he only 
prepares a millionth, billionth, trillionth, and similar 
fractions of it, all of winch, added together, would 
constitute but a vastly minute portion of the drop 
with which he began. But now let us suppose we take 
one single drop of the Tincture of Camomile, and that 
the whole of this were to be carried through the com- 
mon series of dilutions. 

A calculation nearly like the following was made 
by Dr. Panvini, and may be readily followed in its 
essential particulars by any one who chooses. 

For the first dilution it would take 100 drops of al- 
cohol. 

For the second dilution it would take 10,000 drops, 
or about a pint. 

For the third dilution it would take 100 pints. 

For the fourth dilution it would take 10,000 pints, 
or more than 1,000 gallons, and so on to the ninth 
dilution, which would take ten billion gallons, which 
he computed would fill the basin of Lake Agnano, a 
body of water two miles in circumference. The twelfth 
d^ution would of course fill a million such lakes. By 
tne time the seventeenth degree of dilution should be 
reached, the alcohol required would equal in quantity 
the waters of ten thousand Adriatic seas. Trifling er- 
rors must be expected, but they are as likely to be on 
one side as the other, and any little matter like Lake 
Superior or the Caspian would be but a drop in the 
bucket. 

Swallowers of globules, one of your little pellets, 
moistened in the mingled waves of one million lakes 
of alcohol, each two miles in circumference, with 
which had been blended that one drop of Tincture 



54 MEDICAL ESSAYS. 

of Camomile, would be of precisely the strength rec- 
ommended for that medicine in your favorite Jahr's 
Manual, against the most sudden, frightful, and fatal 
diseases ! ° 

And proceeding on the common data, I have just 
made a calculation which shows that tins single drop 
of Tincture of Camomile, given in the quantity or- 
dered by Jahr's Manual, would have supplied every 
individual of the whole human family, past and pres- 
ent, with more than five billion doses each, the action 
of each dose lasting about four days. 

Yet this is given only at the quadriHionth, or 
fourth degree of potency, and various substances are 
frequently acbninistered at the decillionth or tenth 
degree, and occasionally at still higher attenuations 
with professed medicinal results. Is there not in 
tins as great an exception to all the hitherto received 
laws of nature as in the miracle of the loaves and 
fishes ? Ask this question of a Homceopathist, and 
he will answer by referring to the effects produced 
by a very minute portion of vaccine matter, or the 
extraordinary diffusion of odors. But the vaccine 
matter is one of those substances called morbid p '>- 
so?is, of which it is a peculiar character to multiply 

° In the French edition of 1834, the proper doses of the medi- 
cines are mentioned, and Camomile is marked IV. Why are 
the doses omitted in Hull's Translation, except in three in- 
stances out of the whole two hundred remedies, notwithstanding 
the promise in the preface that " some remarks upon the doses 
used may be found at the head of each medicine"? Possibly 
because it makes no difference whether they are employed in 
oni' Homoeopathic dose or another ; but then it is very singular 
that such precise directions were formerly given in the same 
work, and that Hahnemann's " experience " should have led 
him to draw the nice distinctions we have seen in a former part 
of this Lecture (p. 44). 



HOMCEOPATHY AND ITS KINDRED DELUSIONS. 55 

themselves, when introduced into the system, as a 
seed does in the soil. Therefore the hundredth part 
of a grain of the vaccine matter, if no more than this 
is employed, soon increases in quantity, until, in the 
course of about a week, it is a grain or more, and 
can be removed in considerable drops. And what 
is a very curious illustration of Homoeopathy, it does 
not produce its most characteristic effects until it is 
already in sufficient quantity not merely to be visible, 
but to be collected for further use. The thought- 
lessness which can allow an inference to be extended 
from a product of disease possessing this susceptibil- 
ity of multiplication when conveyed into the living 
body, to substances of inorganic origin, such as silex 
or sulphur, would be capable of arguing that a pebble 
may produce a mountain, because an acorn can become 
a forest. 

As to the analogy to be found between the alleged 
action of the infinitely attenuated doses, and the ef- 
fects of some odorous substances which possess the 
extraordinary power of diffusing their imponderable 
emanations through a very wide space, however it may 
be abused in argument, and rapidly as it evaporates 
on examination, it is not like that just mentioned, 
wholly without meaning. The fact of the vast diffu- 
sion of some odors, as that of musk or the rose, for 
instance, has long been cited as the most remarkable 
illustration of the divisibility of matter, and the 
nicety of the senses. And if this were compared 
with the effects of a very minute dose of morphia on 
the whole system, or the sudden and fatal impression 
of a single drop of prussic acid, or, with what comes 
still nearer, the poisonous influence of an atmosphere 
impregnated with invisible malaria, we should find in 



56 MEDICAL ESSAYS. 

each of these examples an evidence of the degree to 
which nature, in some few instances, concentrates 
powerful qualities in minute or subtile forms of mat- 
ter. But if a man comes to me with a pestle and 
mortar in his hand, and tells me that he will take a 
little speck of some substance which nobody ever 
thought to have any smell at all, as, for instance, a 
grain of chalk or of charcoal, and that he will, after 
an hour or two of rubbing and scraping, develop in a 
portion of it an odor which, if the whole gram were 
used, would be capable of pervading an apartment, a 
house, a village, a province, an empire, nay, the entire 
atmosphere of this broad planet upon which we tread ; 
and that from each of fifty or sixty substances he 
can in this way develop a distinct and hitherto un- 
known odor ; and if lie tries to show that all this is 
rendered quite reasonable by the analogy of musk 
and roses, I shall certainly be justified in considering 
him incapable of reasoning, and beyond the reach of 
my argument. What if, instead of this, he professes 
to develop new and wonderful medicinal powers from 
the same speck of chalk or charcoal, in such propor- 
tions as would impregnate every pond, lake, river, sea, 
and ocean of our globe, and appeals to the same anal- 
ogy in favor of the probability of his assertion. 

All this may be true, notwithstanding these consid- 
erations. But so extraordinary would be the fact, that 
a single atom of substances which a child might swal- 
low without harm by the teaspoonful could, by an 
easy mechanical process, be made to develop such in- 
conceivable powers, that nothing but the strictest 
agreement of the most cautious experimenters, secured 
by every guaranty that they were honest and faithful, 
appealing to repeated experiments in public, with 



HOMCEOPATHY AND ITS KINDRED DELUSIONS. 57 

every precaution to guard against error, and with the 
most plain and peremptory results, should induce us 
to lend any credence to such pretensions. 

The third doctrine, that Psora, the other name of 
which you remember, is the cause of the great major- 
ity of chronic diseases, is a startling one, to say the 
least. That an affection always recognized as a very 
unpleasant personal companion, but generally regarded 
as a mere temporary incommodity, readily yielding to 
treatment in those unfortunate enough to suffer from 
it, and hardly known among the better classes of soci- 
ety, should be all at once found out by a German phy- 
sician to be the great scourge of mankind, the cause of 
their severest bodily and mental calamities, cancer and 
consumption, idiocy and madness, must excite our un- 
qualified surprise. And when the originator of this 
singular truth ascribes, as in the page now open before 
me, the declining health of a disgraced courtier, the 
chronic malady of a bereaved mother, even the melan- 
choly of the love-sick and slighted maiden, to nothing 
more nor less than the insignificant, unseemly, and al- 
most unmentionable itch, does it not seem as if the 
very soil upon which we stand were dissolving into 
chaos, over the earthquake-heaving of discovery ? 

And when one man claims to have established these 
three independent truths, which are about as remote 
from each other as the discovery^ of the law of gravita- 
tion, the invention of printing, and that of the mari- 
ner's compass, unless the facts in their favor are over- 
whelming and unanimous, the question naturally arises, 
Is not this man deceiving himself, or trying to deceive 
others ? 

I proceed to examine the proofs of the leading ideas 
of Hahnemann and his school. 



58 MEDICAL ESSAYS. 

In order to show the axiom, similia similibits cu- 
rantur (or like is cured by like), to be the basis of the 
healing art, — " the sole law of nature in therapeu- 
tics," — it is necessary, — 

1. That the symptoms produced by drugs in healthy 
persons should be faithfully studied and recorded. 

2. That drugs should be shown to be always capa- 
ble of curing those diseases most like their own symp- 
toms. 

3. That remedies should be shown not to cure dis- 
eases when they do not produce symptoms resembling 
those presented in these diseases. 

1. The effects of drugs upon healthy persons have 
been studied by Hahnemann and his associates. Their 
results were made known in his Materia Mediea, a 
work in three large volumes in the French translation, 
published about eight years ago. The mode of exper- 
imentation appears to have been, to take the substance 
on trial, either in common or minute doses, and then 
to set down every little sensation, every little move- 
ment of mind or body, which occurred within many 
succeeding hours or days, as being produced solely by 
the substance employed. When I have enumerated 
some of the symptoms attributed to the power of the 
drugs taken, you will be able to judge how much value 
is to be ascribed to the assertions of such observers. 

The following list was taken literally from the Ma- 
teria Mediea of Hahnemann, by my friend M. Ver- 
nois, for whose accuracy I am willing to be responsi- 
ble, lie has given seven pages of these symptoms, not 
selected, but taken at hazard from the French transla- 
tion of the work. I shall be very brief in my citations. 

" After stooping some time, sense of painful weight 
about the head upon resuming the erect posture." 



HOMCEOPATHY AND ITS KINDRED DELUSIONS. 59 

" An itching, tickling sensation at the outer edge of 
the palm of the left hand, which obliges the person to 
scratch." The medicine was acetate of lime, and as 
the action of the globule taken is said to last twenty- 
eight days, you may judge how many such symptoms 
as the last might be supposed to happen. 

Among the symptoms attributed to muriatic acid 
are these : a catarrh, sighing, pimples ; " after having 
written a long thne with the back a little bent over, 
violent pain in the back and shoulder-blades, as if 
from a strain," — " dreams which are not remembered, 
— disposition to mental dejection, — wakefulness be- 
fore and after midnight." 

I might extend this catalogue almost indefinitely. I 
have not cited these specimens with any view to excit- 
ing a sense of the ridiculous, which many others of 
those mentioned would not fail to do, but to show that 
the common accidents of sensation, the little bodily in- 
conveniences to which all of us are subject, are seri- 
ously and systematically ascribed to whatever medicine 
may have been exhibited, even in the minute doses I 
have mentioned, whole days or weeks previously. 

To these are added all the symptoms ever said by 
anybody, whether deserving confidence or not, as I 
shall hereafter illustrate, to be produced by the sub- 
stance in question. 

The effects of sixty-four medicinal substances, as- 
certained by one or both of these methods, are enumer- 
ated in the Materia Medica of Hahnemann, which 
may be considered as the basis of practical Homoe- 
opathy. In the Manual of Jahr, which is the common 
guide, so far as I know, of those who practise Homoe- 
opathy in these regions, two hundred remedies are 
enumerated, many of which, however, have never been 



60 MEDICAL ESSAYS. 

employed in practice. In at least one edition there 
were no means of distinguishing those which had been 
tried upon the sick from the others. It is true that 
marks have been added in the edition employed here, 
which serve to distinguish them ; but what are we to 
think of a standard practical author on Materia Med- 
ica, who at one time omits to designate the proper 
doses of his remedies, and at another to let us have 
any means of knowing whether a remedy has ever 
been tried or not, while he is recommending its em- 
ployment in the most critical and threatening diseases ? 

I think that, from what I have shown of the char- 
acter of Hahnemann's experiments, it would be a sat- 
isfaction to any candid inquirer to know whether 
other persons, to whose assertions he could look with 
confidence, confirm these pretended facts. Now there 
are many individuals, long and well known to the sci- 
entific world, who have tried these experiments upon 
healthy subjects, and utterly deny that their effects 
have at all corresponded to Hahnemann's assertions. 

I will take, for instance, the statements of Andral 
(and I am not referring to his well-known public ex- 
periments in his hospital) as to the result of his own 
trials. This distinguished physician is Professor of 
Medicine in the School of Paris, and one of the most 
widely known and valued authors upon practical and 
theoretical subjects the profession can claim in any 
country. He is a man of great kindness of character, 
a most liberal eclectic by nature and habit, of unques- 
tioned integrity, and is called, in the leading article of 
the first number of the " Homoepathic Examiner," " an 
eminent and' very enlightened allopathist." Assisted 
by a number of other persons in good health, he ex- 
perimented on the effects of cinchona, aconite, sulphur, 



HOMCEOPATHY AND ITS KINDRED DELUSIONS. 61 

arnica, and the other most highly extolled remedies. 
His experiments lasted a year, and he stated publicly 
to the Academy of Medicine that they never pro- 
duced the slightest appearance of the symptoms at- 
tributed to them. The results of a man like this, so 
extensively known as one of the most philosophical 
and candid, as well as brilliant of instructors, and 
whose admirable abilities and signal liberality are gen- 
erally conceded, ought to be of great weight in decid- 
ing the question. 

M. Double, a well-known medical writer and a phy- 
sician of high standing in Paris, had occasion so long 
ago as 1801, before he had heard of Homoeopathy, to 
make experiments upon Cinchona, or Peruvian bark. 
He and several others took the drug in every kind of 
dose for four months, and the fever it is pretended by 
Hahnemann to excite never was produced. 

M. Bonnet, President of the Royal Society of Medi- 
cine of Bordeaux, had occasion to observe many sol- 
diers during the Peninsular War, who made use of 
Cinchona as a preservative against different diseases, 
— but he never found it to produce the pretended par- 
oxysms. 

If any objection were made to evidence of this kind, 
I would refer to the express experiments on many of 
the Homoeopathic substances, which were given to 
healthy persons with every precaution as to diet and 
regimen, by M. Louis Fleury, without being followed 
by the slightest of the pretended consequences. And 
let me mention as a curious fact, that the same quan- 
tity of arsenic given to one animal in the common form 
of the unprepared powder, and to another after hav- 
ing been rubbed up into six hundred globules, offered 
no particular difference of activity in the two cases. 



62 MEDICAL ESSAYS. 

This is a strange contradiction to the doctrine of the 
development of what they call dynamic power, by 
means of friction and subdivision. 

In 1835 a public challenge was offered to the best- 
known Homoeopathic physician in Paris to select any 
ten substances asserted to produce the most striking 
effects ; to prepare them himself ; to choose one by lot 
without knowing which of them he had taken, and try 
it upon himself or any intelligent and devoted Homce- 
opathist, and, waiting his own time, to come forward 
and tell what substance had been employed. The 
challenge was at first accepted, but the acceptance re- 
tracted before the time of trial arrived. 

From all this I think it fair to conclude that the cat- 
alogues of symptoms attributed in Homoeopathic works 
to the influence of various drugs upon healthy persons 
are not entitled to any confidence. 

2. It is necessary to show, in the next place, that 
medicinal substances are always capable of curing dis- 
eases most like their own symptoms. For facts relat- 
ing to this question we must look to two sources ; the 
recorded experience of the medical profession in gen- 
eral, and the results of trials made according to Homoe- 
opathic principles, and capable of testing the truth of 
the doctrine. 

No person, that I am aware of, has ever denied that 
in some cases there exists a resemblance between the 
effects of a remedy and the symptoms of diseases in 
which it is beneficial. This lias been recognized, as 
Hahnemann himself has shown, from the time of Hip- 
pocrates. But according to the records of the medi- 
cal profession, as they have been hitherto interpreted, 
this is true of only a very small proportion of useful 
remedies. Nor has it ever been considered as an es- 



HOMCEOPATHY AND ITS KINDKED DELUSIONS. 63 

tablished truth that the efficacy of even these few rem- 
edies was in any definite ratio to their power of pro- 
ducing symptoms more or less like those they cured. 

Such was the state of opinion when Hahnemann 
came forward with the proposition that all the cases of 
successful treatment found in the works of all preced- 
ing medical writers were to be ascribed solely to the 
operation of the Homoeopathic principle, which had 
effected the cure, although without the physician's 
knowledge that this was the real secret. And strange 
as it may seem, he was enabled to give such a degree 
of plausibility to this assertion, that any person not ac- 
quainted somewhat with medical literature, not quite 
familiar, I should rather say, with the relative value of 
medical evidence, according to the sources whence it is 
derived, would be almost frightened into the belief, at 
seeing the pages upon pages of Latin names he has 
summoned as Ms witnesses. 

It has hitherto been customary, when examining the 
writings of authors of preceding ages, upon subjects as 
to which they were less enlightened than ourselves, and 
which they were very liable to misrepresent, to exer- 
cise some little discretion; to discriminate, in some 
measure, between writers deserving confidence and 
those not entitled to it. But there is not the least ap- 
pearance of any such delicacy on the part of Hahne- 
mann. A large majority of the names of old authors 
he cites are wholly unknown to science. With some 
of them I have been long acquainted, and I know that 
their accounts of diseases are no more to be trusted 
than their contemporary Ambroise Parens stories of 
mermen, and similar absurdities. But if my judgment 
is rejected, as being a prejudiced one, I can refer to 
Cullen, who mentioned three of Hahnemann's authors 



64 MEDICAL ESSAYS. 

in one sentence, as being " not necessarily bad authori- 
ties ; but certainly sucli when they delivered very im- 
probable events ; " and as this was said more than half 
a century ago, it could not have had any reference to 
Hahnemann. But although not the slightest sign of 
discrimination is visible in his quotations, — although 
for him a handful of chaff from Schenck is all the 
same thing as a measure of wheat from Morgagni, — 
there is a formidable display of authorities, and an 
abundant proof of ingenious researches to be found in 
each of the great works of Hahnemann with which I 
am familiar. 

It is stated by Dr. Leo-Wolf, that Professor Joerg, 
of Leipsic, has proved many of Hahnemann's quota- 
tions from old authors to be adulterate and false. 
What particular instances he has pointed out I have 
no means of learning. And it is probably wholly im- 
possible on this side of the Atlantic, and even in most 
of the public libraries of Europe, to find anything 
more than a small fraction of the innumerable obscure 
publications which the neglect of grocers and trunk- 
makers has spared to be ransacked by the all-devouring 
genius of Homoeopathy. I have endeavored to verify 
such passages as my own library afforded me the 
means of doing. For some I have looked in vain, for 
want, as I am willing to believe, of more exa^t refer- 
ences. But this I am able to affirm, that, out of ^he very 
small number which I have been able to trace back to 

° Some painful surmises might arise as to the erudition of 
Hahnemann's English Translator, who makes two individuals of 
" Zaeutus, Lucitanus," as well as respecting that of the conduc- 
tors of an American Homoeopathic periodical, who suffer the 
name of the world-renowned Cardanus to be spelt C*j*damus in 
at least three places, were not this gross ignorance oi course at- 
tributable only to the printer. 



HOMOEOPATHY AND ITS KINDRED DELUSIONS. 65 

their original authors, I have found two to be wrongly 
quoted, one of them being a gross misrepresentation. 

The first is from the ancient Roman author, Caelius 
Aurelianus; the second from the venerable folio of 
Forestus. Hahnemann uses the following expressions, 
— if he is not misrepresented in the English Transla- 
tion of the "Organon " : " Asclepiades on one occasion 
cured an inflammation of the brain by administering 
a small quantity of wine." After correcting the erro- 
neous reference of the Translator, I can find no such 
case alluded to in the chapter. But Caelius Aurelianus 
mentions two modes of treatment employed by Ascle- 
piades, into both of which the use of wine entered, as 
being" in the highest degree irrational and dangerous." 

In speaking of the oil of anise-seed, Hahnemann 
says that Forestus observed violent colic caused by its 
administration. But, as the author tells the story, a 
young man took, by the counsel of a surgeon, an acrid 
and virulent medicine, the name of which is not given, 
which brought on a most cruel fit of the gripes and 
colic. After this another surgeon was called, who 
gave him oil of anise-seed and wine, which increased 
his suffering. 6 Now if this was the Homoeopathic 
remedy, as Hahnemann pretends, it might be a fair 
question why the young man was not cured by it. 
But it is a much graver question why a man who has 
shrewdness and learning enough to go so far after his 
facts, should think it right to treat them with such 
astonishing negligence or such artful unfairness. 

Even if every word he had pretended to take from 
his old authorities were to be found in them, even if 

a Cazlius Aurel. De Morb. A cut. et Chron. lib. I. cap. xv. not 
Xvi. Amsterdam. TVetstein, 1755. 

6 Observ. et Curat. Med. lib. XXL obs. xiii. Frankfort, 1614. 
5 



66 MEDICAL ESSAYS. 

the authority of every one of these authors were be- 
yond question, the looseness with which they are used 
to prove whatever Hahnemann chooses is beyond the 
bounds of credibility. Let me give one instance to 
illustrate the character of this man's mind. Hahne- 
mann asserts, in a note annexed to the 110th para- 
graph of the " Organon," that the smell of the rose will 
cause certain persons to faint. And he says in the 
text that substances which produce peculiar effects of 
this nature on particular constitutions cure the same 
symptoms in people in general. Then hi another note 
to the same paragraph he quotes the following fact 
from one of the last sources one would have looked to 
for medical information, the Byzantine Historians. 

" It was by these means " (i. c. Homoeopathically) 
" that the Princess Eudosia with rose-water restored 
a person who had fainted ! " 

Is it possible that a man who is guilty of such pe- 
dantic folly as this, — a man who can see a confirma- 
tion of his doctrine in such a recovery as this, — a re- 
covery which is happening every day, from a breath 
of air, a drop or two of water, untying a bonnet- 
string, loosening a stay-lace, and which can hardly 
help happening, whatever is done, — is it possible 
that a man, of whose pages, not here and there one, 
but hundreds upon hundreds are loaded with such 
trivialities, is the Newton, the Columbus, the Harvey 
of the nineteenth century ! 

The whole process of demonstration he employs is 
this. An experiment is instituted with some drug 
upon one or more healthy persons. Everything that 
happens for a number of days or weeks is, as we have 
seen, set down as an effect of the medicine. Old vol- 
umes are then ransacked promiscuously, and every 



HOMCEOPATHY AND ITS KINDRED DELUSIONS. 67 

morbid sensation or change that anybody ever said 
was produced by the drug in question is added to the 
list of synrptonis. By one or both of these methods, 
each of the sixty-four substances enumerated by Hah- 
nemann is shown to produce a very large number of 
symptoms, the lowest in his scale being ninety-seven, 
and the highest fourteen hundred and ninety-one. 
And having made out this list respecting any drug, a 
catalogue which, as you may observe in any Homoeo- 
pathic manual, contains various symptoms belonging 
to every organ of the body, what can be easier than to 
find alleged cures in every medical author which can 
at once be attributed to the Homoeopathic principle ; 
still more if the grave of extinguished credulity is 
called upon to give up its dead bones as living wit- 
nesses ; and worst of all, if the monuments of the past 
are to be mutilated in favor of " the sole law of Nature 
in therapeutics " ? 

There are a few familiar facts of which great use 
has been made as an entering wedge for the Homoeo- 
pathic doctrine. They have been suffered to pass cur- 
rent so long that it is time they should be nailed to 
the counter, a little operation which I undertake, with 
perfect cheerfulness, to perform for them. 

The first is a supposed illustration of the Homoeo- 
pathic law found in the precept given for the treat- 
ment of parts which have been frozen, by friction with 
snow or similar means. But we deceive ourselves by 
names, if we suppose the frozen part to be treated by 
cold, and not by heat. The snow may even be act- 
ually warmer than the part to which it is applied. 
But even if it were at the same temperature when ap- 
plied, it never did and never could do the least good 
to a frozen part, except as a mode of regulating the 



68 MEDICAL ESSAYS. 

application of what? of heat. But the heat must be 
applied gradually, just as food must be given a little 
at a time to those perishing with hunger. If the pa- 
tient were brought into a warm room, heat would be 
applied very rapidly, were not something interposed 
to prevent this, and allow its gradual admission. 
Snow or iced water is exactly what is wanted ; it is 
not cold to the part ; it is very possibly warm, on the 
contrary, for these terms are relative, and if it does 
not melt and let the heat in, or is not taken away, the 
part will remain frozen up until doomsday. Now the 
treatment of a frozen limb by heat, in large or small 
quantities, is not Homoeopathy. 

The next supposed illustration of the Homoeopathic 
law is tha alleged successful management of burns, by 
holding them to the fire. This is a popular mode of 
treating those burns which are of too little consequence 
to require any more efficacious remedy, and would 
inevitably get well of themselves, without any trouble 
being bestowed upon them. It produces a most acute 
pain in the part, which is followed by some loss of 
sensibility, as happens with the eye after exposure 
to strong light, and the ear after being subjected 
to very intense sounds. This is all it is capable of 
doing, and all further notions of its efficacy must be 
attributed merely to the vulgar love of paradox. If 
this example affords any comfort to the Homoeopathist, 
it seems as cruel to deprive him of it as it would be to 
convince the mistress of the smoke-jack or the flat- 
iron that the fire does not literally "draw the Ore 
out,"' which is her hypothesis. 

But if it were true that frost-bites were cured by 
cold and burns by heat, it would be subversive, so 
far as it went, of the great principle of Homoeopathy. 



HOMOEOPATHY AND ITS KINDRED DELUSIONS. 69 

For you will remember that this principle is that 
Like cures Like, and not that Same cures Same; 
that there is resemblance and not identity between 
the symptoms of the disease and those produced by 
the drug which cures it, and none have been readier 
to insist upon this distinction than the Homoeopa- 
tliists themselves. For if Same cures Same, then 
every poison must be its own antidote, — which is 
neither a part of their theory nor their so-called ex- 
perience. They have been asked often enough, why 
it was that arsenic could not cure the mischief which 
arsenic had caused, and why the infectious cause 
of small-pox did not remedy the disease it had pro- 
duced, and then they were ready enough to see the 
distinction I have pointed out. O no ! it was not the 
hair of the same dog, but only of one very much like 
him ! 

A third instance in proof of the Homoeopathic law 
is sought for in the acknowledged efficacy of vaccina- 
tion. And how does the law apply to this? It is 
granted by the advocates of Homoeopathy that there is 
a resemblance between the effects of the vaccine virus 
on a person in health and the symptoms of small-pox. 
Therefore, according to the rule, the vaccine virus 
will cure the small-pox, which, as everybody knows, is 
entirely untrue. But it prevents small-pox, say the 
Homoeopathists. Yes, and so does small-pox prevent 
itself from ever happening again, and we know just 
as much of the principle involved in the one case as 
in the other. For this is only one of a series of facts 
which we are wholly unable to explain. Small-pox, 
measles, scarlet-fever, hooping-cough, protect those 
who have them once from future attacks ; but nettle- 
rash and catarrh and lung fever, each of which is 



70 MEDICAL ESSAYS. 

just as Homoeopathic to itself as any one of the others, 
have no such preservative power. We are obliged to 
accept the fact, unexplained, and we can do no more 
for vaccination than for the rest. 

I come now to the most directly practical point 
connected with the subject, namely, — 

"What is the state of the evidence as to the efficacy 
of the proper Homoeopathic treatment in the cure of 
diseases. 

As the treatment adopted by the Homoeopathists 
has been almost universally by means of the infini- 
tesimal doses, the question of their efficacy is thrown 
open, in common with that of the truth of their fun- 
damental axiom, as both are tested in practice. 

We must look for facts as to the actual working of 
Homoeopathy to three sources. 

1. The statements of the unprofessional public. 

2. The assertions of Homoeopathic practitioners. 

3. The results of trials by competent and honest 
physicians, not pledged to the system. 

I think, after what we have seen of medical facts, as 
they are represented by incompetent persons, we are 
disposed to attribute little value to all statements of 
wonderful cures, coining- from those who have never 
been accustomed to watch the caprices of disease, and 
have not cooled down their young enthusiasm by the 
habit of tranquil observation. Those who know noth- 
ing of the natural progress of a malady, of its ordinary 
duration, of its various modes of terminating, of its lia- 
bility to accidental complications, of the signs which 
mark its insignificance or severity, of what is to be ex- 
pected of it when left to itself, of how much or how lit- 
tle is to be anticipated from remedies, those who know 



PIOMCEOPATHY AND ITS KINDRED DELUSIONS. 71 

nothing or next to nothing of all these things, and who 
are in a great state of excitement from benevolence, 
sympathy, or zeal for a new medical discovery, can 
hardly be expected to be sound judges of facts which 
have misled so many sagacious men, who have spent 
their lives in the daily study and observation of them. 
I believe that, after having drawn the portrait of de- 
funct Perkinism, with its five thousand printed cures, 
and its million and a half computed ones, its miracles 
blazoned about through America, Denmark, and Eng- 
land ; after relating that forty years ago women car- 
ried the Tractors about in their pockets, and workmen 
could not make them fast enough for the public de- 
mand ; and then showing you, as a curiosity, a single 
one of these instruments, an odd one of a pair, which 
I obtained only by a lucky accident, so utterly lost is 
the memory of all their wonderful achievements ; I 
believe, after all this, I need not waste time in showing 
that medical accuracy is not to be looked for in the 
florid reports of benevolent associations, the assertions 
of illustrious patrons, the lax effusions of daily jour- 
nals, or the effervescent gossip of the tea-table. 

Dr. Hering, whose name is somewhat familiar to the 
champions of Homoeopathy, has said that " the new 
healing art is not to be judged by its success in isolated 
cases only, but according to its success in general, its 
innate truth, and the incontrovertible nature of its in- 
nate principles." 

We have seen something of " the incontrovertible 
nature of its innate principles," and it seems probable, 
on the whole, that its success in general must be made 
up of its success in isolated cases. Some attempts 
have been made, however, to finish the whole matter 
by sweeping statistical documents, which are intended 



72 MEDICAL ESSAYS. 

to prove its triumphant success over the common prac- 
tice. 

It is well known to those who have had the good 
fortune to see the " Homoeopathic Examiner," that this 
journal led off, in its first number, with a grand dis- 
play of everything the newly imported doctrine had to 
show for itself. It is well remarked, on the twenty- 
third page of this article, that " the comparison of bills 
of mortality among an equal number of sick, treated 
by divers methods, is a most poor and lame way to get 
at conclusions touching principles of the healing art." 
In confirmation of which, the author proceeds upon the 
twenty-fifth page to prove the superiority of the Homoe- 
opathic treatment of cholera, by precisely these very 
bills of mortality. Now. every intelligent physician is 
aware that the poison of cholera differed so much in its 
activity at different times and places, that it was next 
to impossible to form any opinion as to the results of 
treatment, unless every precaution was taken to secure 
the most perfectly corresponding conditions in the 
patients treated, and hardly even then. Of course, 
then, a Russian Admiral, by the name of Mordvinow, 
backed by a number of so-called physicians practising 
in Russian villages, is singularly competent to the task 
of settling the whole question of the utility of this or 
that kind of treatment ; to prove that, if not more 
than eight and a half per cent, of those attacked with 
the disease perished, the rest owed their immunity to 
Hahnemann. I can remember when more than a hun- 
dred patients in a public institution were attacked 
with what, I doubt not, many Homoeopathic physicians 
(to say nothing of Homoeopathic admirals) would 
have called cholera, and not one of them died, though 
treated in the common way, and it is my firm belief, 



HOMOEOPATHY AND ITS KINDRED DELUSIONS. 73 

that, if such a result had followed the administration 
of the omnipotent globules, it would have been in the 
mouth of every adept in Europe, from Quin of Lon- 
don to Spohr of Gandersheim. No longer ago than 
yesterday, in one of the most widely circulated papers 
of this city, there was published an assertion that the 
mortality in several Homoeopathic Hospitals was not 
quite five in a hundred, whereas, in what are called 
by the writer Allopathic Hospitals, it is said to be 
eleven in a hundred. An honest man should be 
ashamed of such an argumentum ad ignorantiam. 
The mortality of a hospital depends not merely on the 
treatment of the patients, but on the class of diseases 
it is in the habit of receiving, on the place where it is, 
on the season, and many other circumstances. For in- 
stance, there are many hospitals in the great cities of 
Europe that receive few diseases of a nature to endan- 
ger life, and, on the other hand, there are others where 
dangerous diseases are accumulated out of the com- 
mon proportion. Thus, in the wards of Louis, at the 
Hospital of La Piti£, a vast number of patients in the 
last stages of consumption were constantly entering, 
to swell the mortality of that hospital. It was be- 
cause he was known to pay particular attention to the 
diseases of the chest that patients laboring under 
those fatal affections to an incurable extent were so 
constantly coming in upon him. It is always a miser- 
able appeal to the thoughtlessness of the vulgar, to al- 
lege the naked fact of the less comparative mortality 
in the practice of one hospital or of one physician 
than another, as an evidence of the superiority of 
their treatment. Other things being equal, it must 
always be expected that those institutions and individ- 
uals enjoying to the highest degree the confidence of 



74 



MEDICAL ESSAYS. 



the community will lose the largest proportion of their 
patients ; for the simple reason that they will natu- 
rally be looked to by those suffering from the gravest 
class of diseases ; that many, who know that they are 
affected with mortal disease, will choose to die under 
their care or shelter, while the subjects of trifling mal- 
adies, and merely troublesome symptoms, amuse them- 
selves to any extent among the fancy practitioners. 
When, therefore, Dr. Muhlenbein, as stated in the 
"Homoeopathic Examiner," and quoted in yesterday's 
"Daily Advertiser," asserts that the mortality among 
his patients is only one per cent, since he has practised 
Homoeopathy, whereas it was six per cent, when he 
employed the common mode of practice, I am con- 
vinced by this, his own statement, that the citizens of 
Brunswick, whenever they are seriously sick, take 
good care not to send for Dr. Muhlenbein ! 

It is evidently impossible that I should attempt, 
within the compass of a single lecture, any detailed 
examination of the very numerous cases reported in 
the Homoeopathic Treatises and Journals. Having 
been in the habit of receiving the French " Archives of 
Homoeopathic Medicine" until the premature decease 
of that Journal, I have had the opportunity of becom- 
ing acquainted somewhat with the style of these doc- 
uments, and experiencing whatever degree of convic- 
tion they were calculated to produce. Although of 
course I do not wish any value to be assumed for my 
opinion, such as it is, I consider that you are entitled 
to hear it. So far, then, as I am acquainted with the 
general character of the cases reported by the Homoe- 
opathic physicians, they would for the most part be 
considered as wholly undeserving a place in any Eng- 
lish, French, or American periodical of liigh standing, 



HOMOEOPATHY AND ITS KINDRED DELUSIONS. 75 

if, instead of favoring the doctrine they were intended 
to support, they were brought forward to prove the 
efficacy of any common remedy administered by any 
common practitioner. There are occasional exceptions 
to this remark ; but the general truth of it is rendered 
probable by the fact that these cases are always, or 
ahnost always, written with the single object of show- 
ing the efficacy of the medicine used, or the skill of 
the practitioner, and it is recognized as a general rule 
that such cases deserve very little confidence. Yet 
they may sound well enough, one at a time, to those 
who are not fully aware of the fallacies of medical 
evidence. Let me state a case in illustration. Nobody 
doubts that some patients recover under every form of 
practice. Probably all are willing to allow that a 
large majority, for instance, ninety in a hundred, of 
such cases as a physician is called to in daily practice, 
would recover, sooner or later, with more or less diffi- 
culty, provided nothing were done to interfere seri- 
ously with the efforts of nature. 

Suppose, then, a physician who has a hundred pa- 
tients prescribes to each of them pills made of some 
entirely inert substance, as starch, for instance. Ninety 
of them get well, or if he chooses to use such language, 
he cures ninety of them. It is evident, according to 
the doctrine of chances, that there must be a consider- 
able number of coincidences between the relief of the 
patient and the administration of the remedy. It is 
altogether probable that there will happen two or three 
very striking coincidences out of the whole ninety 
cases, in which it would seem evident that the medi- 
cine produced the relief, though it had, as we assumed, 
nothing to do with it. Now suppose that the physi- 
cian publishes these cases, will they not have a plausi- 



76 MEDICAL ESSAYS. 

ble appearance of proving that which, as we granted 
at the outset, was entirely false? Suppose that in- 
stead of pills of starch he employs microscopic sugar- 
plums, with the five million billion trilliontli part of a 
suspicion of aconite or pulsatilla, and then publishes 
his successful cases, through the leaden lips of the 
press, or the living ones of his female acquaintances, 
— does that make the impression a less erroneous 
one? But so it is that in Homoeopathic works and 
journals and gossip one can never, or next to never, 
find anything but successful cases, which might do 
very well as a proof of superior skill, did it not prove 
as much for the swindling advertisers whose certifi- 
cates disgrace so many of our newspapers. How long 
will it take mankind to learn that while they listen to 
"the speaking hundreds and units, who make the 
world ring " with the pretended triumphs they have 
witnessed, the " dumb millions " of deluded and in- 
jured victims are paying the daily forfeit of their mis- 
placed confidence ! 

I am sorry to see, also, that a degree of ignorance 
as to the natural course of diseases is often shown in 
these published cases, which, although it may not be 
detected by the unprofessional reader, conveys an un- 
pleasant impression to those who are acquainted with 
the subject. Thus a young woman affected with, jaun- 
dice is mentioned in the German " Annals of Clinical 
Homoeopathy" as having been cured in twenty-nine 
days by pulsatilla and mix vomica. Rummel, a well- 
known writer of the same school, speaks of curing a 
case of jaundice in thirty-four days by Homoeopathic 
doses of pulsatilla, aconite, and cinchona. I happened 
to have a case in my own household, a few weeks 
since, winch lasted about ten days, and this was longer 



HOMOEOPATHY AND ITS KINDRED DELUSIONS. 77 

than I have repeatedly seen it in hospital practice, so 
that it was nothing to boast of. 

Dr. Miuineche of Liehtenburg in Saxony is called 
to a patient with sprained ankle who had been a fort- 
night under the common treatment. The patient gets 
well by the use of arnica in a little more than a month 
longer, and this extraordinary fact is published in the 
French " Archives of Homoeopathic Medicine." 

In the same Journal is recorded the case of a patient 
who with nothing more, so far as any proof goes, than 
influenza, gets down to her shop upon the sixth day. 

And again, the cool way in which everything favor- 
able in a case is set down by these people entirely to 
their treatment, may be seen in a case of croup re- 
ported in the " Homoeopathic Gazette " of Leipsic, in 
which leeches, blistering, inhalation of hot vapor, and 
powerful internal medicine had been employed, and 
yet the merit was all attributed to one drop of some 
Homoeopathic fluid. 

I need not multiply these quotations, which illus- 
trate the grounds of an opinion which the time does 
not allow me to justify more at length ; other such 
cases are lying open before me ; there is no end to 
them if more were wanted ; for nothing is necessary 
but to look into any of the numerous broken-down 
Journals of Homoeopathy, the volumes of which may 
be found on the shelves of those curious in such mat- 
ters. 

A number of public trials of Homoeopathy have 
been made in different parts of the world. Six of 
these are mentioned in the Manifesto of the " Homoe- 
opathic Examiner." Now to suppose that any trial 
can absolutely silence people, would be to forget the 
whole experience of the past. Dr. Haygarth and Dr. 



78 MEDICAL ESSAYS. 

Alderson could not stop the sale of the five-guinea 
Tractors, although they proved that they could work 
the same miracles with pieces of wood and tobacco- 
pipe. It takes time for truth to operate as well as 
Homoeopathic globules. Many persons thought the re- 
sults of these trials were decisive enough of the nul- 
lity of the treatment ; those who wish to see the kind 
of special pleading and evasion by which it is at- 
tempted to cover results which, stated by the " Homoe- 
opathic Examiner " itself, look exceedingly like a mis- 
erable failure, may consult the opening flourish of that 
Journal. I had not the intention to speak of these 
public trials at all, having abundant other evidence on 
the point. But I think it best, on the whole, to men- 
tion two of them in a few words, — that instituted at 
Naples and that of Andral. 

There have been few names in the medical pro- 
fession, for the last half century, so widely known 
throughout the world of science as that of M. Esquirol, 
whose life was devoted to the treatment of insanity, 
and who was without a rival in that department of 
practical medicine. It is from an analysis communi- 
cated by him to the "Gazette Medieale de Paris " that 
I derive my acquaintance with the account of the trial 
at Naples by Dr. Panvini, physician to the Hospital 
della Pace. This account seems to be entirely deserving 
of credit. Ten patients were set apart, and not allowed 
to take any medicine at all, — much against the wish 
of the Homoeopathic physician. All of them got well, 
and of course all of them would have been claimed 
as triumphs if they had been submitted to the treat- 
ment. Six other slight cases (each of which is speci- 
fied) got well under the Homoeopathic treatment, — ■ 
none of its asserted specific effects being manifested 



HOMCEOPATHY AND ITS KINDRED DELUSIONS. 79 

All the rest were cases of grave disease ; and so far as 
the trial, which was interrupted about the fortieth 
day, extended, the patients grew worse, or received no 
benefit. A case is reported on the page before me of 
a soldier affected with acute inflammation in the chest, 
who took successively aconite, bryonia, nux vomica, 
and pulsatilla, and after thirty-eight days of treatment 
remained without any important change in his disease. 
The Homoeopathic physician who treated these pa- 
tients was M. de Horatiis, who had the previous year 
been announcing his wonderful cures. And M. Es- 
quirol asserted to the Academy of Medicine in 1835, 
that this M. de Horatiis, who is one of the prominent 
personages in the " Examiner's " Manifesto published 
in 1840, had subsequently renounced Homoeopathy. I 
may remark, by the way, that this same periodical, 
which is so very easy in explaining away the results of 
these trials, makes a mistake of only six years or a 
little more as to the time when this at Naples was in- 
stituted. 

M. Andral, the " eminent and very enlightened allop- 
athist " of the " Homoeopathic Examiner," made the fol- 
lowing statement in March, 1835, to the Academy of 
Medicine : " I have submitted this doctrine to experi- 
ment ; I can reckon at this time from one hundred and 
thirty to one hundred and forty cases, recorded with 
perfect fairness, in a great hospital, under the eye of 
numerous witnesses ; to avoid every objection I ob- 
tained my remedies of M. Guibourt, who ■ keeps a 
Homoeopathic pharmacy, and whose strict exactness 
is well known ; the regimen has been scrupulously 
observed, and I obtained from the sisters attached to 
the hospital a special regimen, such as Hahnemann 
orders. I was told, however, some months since, that 



80 MEDICAL ESSAYS. 

I had not been faithful to all the rules of the doctrine. 
I therefore took the trouble to begin again ; I have 
studied the practice of the Parisian Homceopathists, 
as I had studied their books, and I became convinced 
that they treated their patients as I had treated mine, 
and I affirm that I have been as rigorously exact in 
the treatment as any other person." 

And he expressly asserts the entire nullity of the 
influence of all the Homoeopathic remedies tried by 
him in modifying, so far as he could observe, the prog- 
ress or termination of diseases. It deserves notice 
that he experimented with the most boasted sub- 
stances, — cinchona, aconite, mercury, bryonia, bella- 
donna. Aconite, for instance, he says he administered 
in more than forty cases of that collection of feverish 
symptoms in which it exerts so much power, according 
to Hahnemann, and in not one of them did it have 
the slightest influence, the pulse and heat remaining 
as before. 

These statements look pretty honest, and would 
seem hard to be explained away, but it is calmly said 
that he " did not know enough of the method to select 
the remedies with any tolerable precision." a Who 
are they that practice Homoeopathy, and say this of a 
man with the Materia Medica of Hahnemann lying 
before him? Who are they that send these same 
globules, on which he experimented, accompanied by 
a little book, into families, whose members are thought 
competent to employ them, when they deny any such 

" Homoeopathic Examiner, vol. i. p. 22. 

" Nothing is left to the caprice of the physician. (' In a word, 
instead of being dependent upon blind chance, that there is an 
infallible law, guided by which; the physician must select the 
proper remedies.') " Ibid., in a notice of Menzel's paper. 



HOMOEOPATHY AND ITS KINDRED DELUSIONS. 81 

capacity to a man whose life has been passed at the 
bedside of patients, the most prominent teacher in the 
first Medical Faculty in the world, the consulting phy- 
sician of the King of France, and one of the most 
renowned practical writers, not merely of his nation, 
but of his age ? I leave the quibbles by which such 
persons would try to creep out from under the crushing 
weight of these conclusions to the unfortunates who 
suppose that a reply is equivalent to an answer. 

Dr. Baillie, one of the physicians in the great Hotel 
Dieu of Paris, invited two Homoeopathic practitioners 
to experiment in his wards. One of these was Curie, 
now of London, whose works are on the counters of 
some of our bookstores, and probably in the hands of 
some of my audience. This gentleman, whom Dr. 
Baillie declares to be an enlightened man, and per- 
fectly sincere in his convictions, brought his own 
medicines from the pharmacy which furnished Hah- 
nemann himself, and employed them for four or five 
months upon patients in his ward, and with results 
equally unsatisfactory, as appears from Dr. Baillie 's 
statement at a meeting of the Academy of Medicine. 
And a similar experiment was permitted by the Clin- 
ical Professor of the H6tel Dieu of Lyons, with the 
same complete failure. 

But these are old and prejudiced practitioners. 
Very well, then take the statement of Dr. Fleury, a 
most intelligent young physician, who treated homceo- 
pathically more than fifty patients, suffering from dis- 
eases which it was not dangerous to treat in this way, 
taking every kind of precaution as to regimen, removal 
of disturbing influences, and the state of the atmos- 
phere, insisted upon by the most vigorous partisans 
of the doctrine, and found not the slightest effect pro- 



82 MEDICAL ESSAYS. 

cluced by the medicines. And more than this, read 
nine of these cases, which he has published, as I have 
just done, and observe the absolute nullity of aconite, 
belladonna, and bryonia, against the symptoms over 
which they are pretended to exert such palpable, such 
obvious, such astonishing influences. In the view of 
these statements, it is impossible not to realize the en- 
tire futility of attempting to silence this asserted sci- 
ence by the flattest and most peremptory results of 
experiment. Were all the hospital physicians of Eu- 
rope and America to devote themselves, for the requi- 
site period, to this sole pursuit, and were their results 
to be unanimous as to the total worthlessness of the 
whole system in practice, this slippery delusion would 
slide through their fingers without the slightest discom- 
posure, when, as they supposed, they had crushed every 
joint in its tortuous and trailing body. 

3. I have said, that to show the truth of the Ho- 
moeopathic doctrine, as announced by Hahnemann, it 
would be necessary to show, in the third place, that 
remedies never cure diseases when they are not capa- 
ble of producing similar symptoms. The burden of 
this somewhat comprehensive demonstration lying en- 
tirely upon the advocates of this doctrine, it may be 
left to their mature reflections. 

It entered into my original plan to treat of the doc- 
trine relating to JPs or a, or itch, — an almost insane 
conception, which I am glad to get rid of, for this is a 
subject one does not care to handle without gloves. 
I am saved this trouble, however, by finding that 
many of the disciples of Plahnemann, those disciples 
the very gospel of whose faith stands upon his word, 



HOMOEOPATHY AND ITS KINDRED DELUSIONS. 83 

make very light of his authority on this point, although 
he himself says, " It has cost me twelve years of study 
and research to trace out the source of this incredible 
number of chronic affections, to discover this great 
truth, which remained concealed from all my prede- 
cessors and contemporaries, to establish the basis of 
its demonstration, and find out, at the same time, the 
curative medicines that were fit to combat this hydra 
in all its different forms." 

But, in the face of all this, the following remarks 
are made by Wolff, of Dresden, whose essays, accord- 
ing to the editor of the "Homoeopathic Examiner," 
" represent the opinions of a large majority of Homoe- 
opathists in Europe." 

" It cannot be unknown to any one at all familiar 
with Homoeopathic literature, that Hahnemann's idea 
of tracing the large majority of chronic diseases to 
actual itch has met with the greatest opposition from 
Homoeopathic physicians themselves." And again, 
" If the Psoric theory has led to no proper schism, the 
reason is to be found in the fact that it is almost with- 
out any influence in practice." 

We are told by Jahr, that Dr. Griesselich, " Sur- 
geon to the Grand Duke of Baden," and a " distin- 
guished" Homoeopathist, actually asked Hahnemann 
for the proof that chronic diseases, such as dropsy, for 
instance, never arise from any other cause than itch ; 
and that, according to common report, the venerable 
sage was highly incensed (fort courrouce) with Dr. 
Hartmann, of Leipsic, another " distinguished " Ho- 
moeopathist, for maintaining that they certainly did 
arise from other causes. 

And Dr. Fielitz, in the " Homoeopathic Gazette" of 
Leipsic, after saying, in a good-natured way, that 



84 MEDICAL ESSAYS. 

Psora is the Devil in medicine, and that physicians 
are divided on this point into diabolists and exorcists, 
declares that, according to a remark of Hahnemann, 
the whole civilized world is affected with Psora. I 
must therefore disappoint any advocate of Hahnemann 
who may honor me with his presence, by not attacking 
a doctrine on which some of the disciples of his creed 
would be very happy to have its adversaries waste 
their time and strength. I will not meddle with this 
excrescence, which, though often used in time of peace, 
would be dropped, like the limb of a shell-fish, the mo- 
ment it was assailed ; time is too precious, and the 
harvest of living extravagances nods too heavily to my 
sickle, that I should blunt it upon straw and stubble. 



I will close the subject with a brief examination of 
some of the statements made in Homoeopatliic works, 
and more particularly in the brilliant Manifesto of the 
"Examiner," before referred to. And first, it is there 
stated under the head of " Homoeopathic Literature," 
that " Seven Hundred volumes have been issued 
from the press developing the peculiarities of the sys- 
tem, and many of them possessed of a scientific char- 
acter that savans know well how to respect." If my 
assertion were proper evidence in the case, I should 
declare, that, having seen a good many of these publi- 
cations, from the year 1834, when I bought the work 
of the Rev. Thomas Everest," to within a few weeks, 
when I received my last importation of Homoeopathic 
literature, I have found that all, with a very few ex- 

' Dr. Curie speaks of this silly pamphlet as having been pub- 
lished in 1835. 



HOMOEOPATHY AND ITS KINDRED DELUSIONS. 85 

ceptions, were stitched pamphlets varying from twenty 
or thirty pages to somewhat less than a hundred, and 
generally resembling each other as much as so many 
spelling-books. 

But not being evidence in the case, I will give you 
the testimony of Dr. Trinks, of Dresden, who flour- 
ishes on the fifteenth page of the same Manifesto as 
one of the most distinguished among the Homceopa- 
thists of Europe. I translate the sentence literally 
from the " Archives de la Medecine Homoeopathique." 

" The literature of Homoeopathy, if that honorable 
name must be applied to all kinds of book-making, has 
been degraded to the condition of the humblest servi- 
tude. Productions without talent, without spirit, with- 
out discrimination, flat and pitiful eulogies, exaggera- 
tions surpassing the limits of the most robust faith, 
invectives against such as dared to doubt the dogmas 
which had been proclaimed, or catalogues of remedies ; 
of such materials is it composed ! From distance to 
distance only, have appeared some memoirs useful to 
science or practice, which appear as so many green 
oases in the midst of this literary desert." 

It is a very natural as well as a curious question to 
ask, What has been the success of Homoeopathy in the 
different countries of Europe, and what is its present 
condition ? 

The greatest reliance of the advocates of Homoeopa- 
thy is of course on Germany. We know very little of 
its medical schools, its medical doctrines, or its medi- 
cal men, compared with those of England and France. 
And, therefore, when an intelligent traveller gives a 
direct account from personal inspection of the misera- 
ble condition of the Homoeopathic hospital at Leipsic, 
the first established in Europe, and the first on the list 



86 MEDICAL ESSAYS. 

of the ever-memorable Manifesto, it is easy enough to 
answer or elude the fact by citing various hard names 
of " distinguished " practitioners, which sound just as 
well to the uninformed public as if they were Meckel, 
or Tiedemann, or Langenbeck. Dr. Leo-Wolf, who, 
to be sure, is opposed to Homoeopathy, but who is a 
scholar, and ought to know something of his own coun- 
trymen, assures us that " Dr. Kopp is the only Ger- 
man Homceopathist, if we can call him so, who has 
been distinguished as an author and practitioner be- 
fore he examined this method." And Dr. Lee, the 
same gentleman in whose travels the paragraph relat- 
ing to the Leipsic Hospital is to be found, says the 
same thing. And I will cheerfully expose myself to 
any impertinent remark which it might suggest, to as- 
sure my audience that I never heard or saw one au- 
thentic Homoeopathic name of any country in Europe, 
which I had ever heard mentioned before as connected 
with medical science by a single word or deed suffi- 
cient to make it in any degree familiar to my ears, 
unless Arnold of Heidelberg is the anatomist who dis- 
covered a little nervous centre, called the otic ganglion. 
But you need ask no better proof of who and what the 
German adherents of this doctrine must be, than 
the testimony of a German Homceopathist as to the 
wretched character of the works they manufacture to 
enforce its claims. 

As for the act of this or that government tolerating 
or encouraging Homoeopathy, every person of common 
intelligence knows that it is a mere form granted or 
denied according to the general principles of policy 
adopted in different states, or the degree of influence 
which some few persons who have adopted it may hap- 
pen to have at court. What may be the value of cer- 



HOMOEOPATHY AND ITS KINDRED DELUSIONS. 87 

tain pompous titles with which many of the advocates 
of Homoeopathy are honored, it might be disrespectful 
to question. But in the mean time the judicious in- 
quirer may ponder over an extract which I translate 
from a paper relating to a personage well known to 
the community as Williams the Oculist, with whom 
I had the honor of crossing the Atlantic some years 
since, and who himself handed me two copies of the 
paper in question. 

" To say that he was oculist of Louis XVIII. and of 
Charles X., and that he now enjoys the same title with 
respect to His Majesty, Louis Philippe, and the King 
of the Belgians, is unquestionably to say a great deal ; 
and yet it is one of the least of his titles to public con- 
fidence. His reputation rests upon a basis more sub- 
stantial even than the numerous diplomas with which 
he is provided, than the membership of the different 
medical societies which have chosen him as their asso- 
ciate," etc., etc. 

And as to one more point, it is time that the public 
should fully understand that the common method of 
supporting barefaced imposture at the present day, 
both in Europe and in this country, consists in trump- 
ing up " Dispensaries," " Colleges of Health," and other 
advertising charitable clap-traps, which use the poor 
as decoy-ducks for the rich, and the proprietors of 
which have a strong predilection for the title of " Pro- 
fessor." These names, therefore, have come to be of 
little or no value as evidence of the good character, 
still less of the high pretensions of those who invoke 
their authority. Nor docs it follow, even when a chair 
is founded in connection with a well-known institution, 
that it has either a salary or an occupant ; so that it 
may be, and probably is, a mere harmless piece of tol- 



88 MEDICAL ESSAYS. 

eration on the part of the government if a Professor- 
ship of Homoeopathy is really in existence at Jena or 
Heidelberg. And finally, in order to correct the error 
of any who might suppose that the whole Medical Pro- 
fession of Germany has long since fallen into the de- 
lusions of Hahnemann, I will quote two lines which a 
celebrated anatomist and surgeon (whose name will 
occur again in this lecture in connection with a very 
pleasing letter) addressed to the French Academy of 
Medicine in 1835. " I happened to be in Germany 
some months since, at a meeting of nearly six hundred 
physicians ; one of them wished to bring up the ques- 
tion of Homoeopathy; they would not even listen to 
him." This may have been very impolite and bigoted, 
but that is not precisely the point in reference to which 
I mention the circumstance. 

But if we cannot easily get at Germany, we can 
very easily obtain exact information from France and 
England. I took the trouble to write some months 
ago to two friends in Paris, in whom I could place 
confidence, for information upon the subject. One of 
them answered briefly to the effect that nothing was 
said about it. When the late Curator of the Low- 
ell Institute, at his request, asked about the works 
upon the subject, he was told that they had remained 
a long time on the shelves quite unsalable, and never 
spoken of. 

The other gentleman, whose name is well known to 
my audience, and who needs no commendation of mine, 
had the kindness to procure for me many publications 
upon the subject, and some information which sets the 
whole matter at rest, so far as Paris is concerned. He 

a Dr. Henry J. Bigelow, now Professor of Surgery in Har- 
vard University. 



HOMCEOPATHY AND ITS KINDRED DELUSIONS. 89 

went directly to the Baillieres, the principal and al- 
most the only publishers of all the Homoeopathic 
books and journals in that city. The following facts 
were taken by him from the account-books of this pub- 
lishing firm. Four Homoeopathic Journals have been 
published in Paris ; three of them by the Baillieres. 

The reception they met with may be judged of by 
the following list, showing the number of subscribers 
to each on the books of the publishing firm in Paris 
during several successive years : — 

Year. Subscribers. 

1. Bibliotheque Homoeopathique . . 1833 129 



it it 


1835 


80 


tt tt 


1837 


72 


£( 11 


1839 


55 


tt tt 


1841 


31 


2. Archives de la Medecine Homozopa- 






thique .... 


1834 


186 


tt tt 


1836 


175 


tt tt 


1838 


148 



Changed its name to Journal de la 

Doctrine ITahnemanienne, in . . 1840 114 
Ceased to be published. 

3. Revue Critique et Retrospective de 

la Matiere Medicate 1840 65 

1841 51 

4. A Review published by some other house, which 

lasted one year, and had about fifty subscribers, 

appeared in 1834, 1835. 
These are the only four Journals of Homoeopathy 
ever published in Paris. The Baillieres informed my 
correspondent that the sale of Homoeopathic books was 
much less than formerly, and that consequently they 
should undertake to publish no new books upon the 



90 MEDICAL ESSAYS. 

subject, except those of Jalir or Hahnemann. " This 
man," says my correspondent, — referring to one of 
the brothers, — " the publisher and headquarters of 
Homoeopathy in Paris, informs me that it is going 
down in England and Germany as well as in Paris." 
For all the facts he had stated he pledged himself as 
responsible. 

Homoeopathy was in its prime in Paris, he said, in 
1836 and 1837, and since then has been going down. 

Louis told my correspondent that no person of dis- 
tinction in Paris had embraced Homoeopathy, and that 
it was declining. If you ask who Louis is, I refer 
you to the well-known Homoeopathist, Peschier of Ge- 
neva, who says, addressing him, " I respect no one 
more than yourself ; the feeling which guides your re- 
searches, your labors, and your pen, is so honorable 
and rare, that I could not but bow down before it ; 
and I own, if there were any allopathist who inspired 
me with higher veneration, it would be him and not 
yourself whom I should address." 

Among the names of " Distinguished Homoeopa- 
thists," however, displayed in imposing columns, in 
the index of the " Homoeopathic Examiner," are those 
of Marjolin, Amussat, and Breschet, names well 
known to the world of science, and the last of them 
identified with some of the most valuable contribu- 
tions which anatomical knowledge has received since 
the commencement of the present century. One Dr. 
Croserio, a who stands sponsor for many facts in that 
Journal, makes the following statement among the 
rest : " Professors, who are esteemed among the most 

" This gentleman's distinction is vouched for by Dr. F. Hart- 
man n of Leipsic. Dr. Hartmann's distinction is certified by the 
editor of the Homczopatldc Examiner. 



HOMOEOPATHY AND ITS KINDRED DELUSIONS. 91 

distinguished of the Faculty (Faculte de VJEcole de 
31edecine), both as to knowledge and reputation, have 
openly confessed the power of Homoeopathia in forms 
of disease where the ordinary method of practice 
proved totally insufficient. It affords me the highest 
pleasure to select from among these gentlemen, Mar- 
jolin, Amussat, and Breschet." 

Here is a literal translation of an original letter, 
now in my possession, from one of these Homceopa- 
thists to my correspondent : — 

"Dear Sir, and respected professional Brother: — 

" You have had the kindness to inform me in your 
letter that a new American Journal, the 4 New World,' a 
has made use of my name in support of the pretended 
Homoeopathic doctrines, and that I am represented as 
one of the warmest partisans of Homoeopathy in 
France. 

" I am vastly surprised at the reputation manufac- 
tured for me upon the new continent ; but I am 
obliged, in deference to truth, to reject it with my 
whole energy. I spurn far from me everything which 
relates to that charlatanism called Homoeopathy, for 
these pretended doctrines cannot endure the scrutiny 
of wise and enlightened persons, who are guided by 
honorable sentiments in the practice of the noblest of 
arts. " I am, etc., etc., 

" G. Breschet, 

" Professor in the Faculty of Medicine, 
Member of the Institute, Surgeon of 
Hotel Dieu, and Consulting Surgeon 
to the King, etc. 
"Paris, 3c? November, 1841." 

° I first saw M. Breschet's name mentioned in that Journal. 



92 MEDICAL ESSAYS. 

Concerning Arrmssat, my correspondent writes, that 
lie was informed by Madame Hahnemann, who con- 
verses in French more readily than her husband, and 
therefore often speaks for him, that " he was not a 
physician, neither Homceopathist nor Allopathist, but 
that he was the surgeon of their own establishment ; 
that is, performed as a surgeon all the operations they 
had occasion for in their practice." 

I regret not having made any inquiries as to Mar- 
jolin, who, I doubt not, would strike his ponderous 
snuff-box until it resounded like the Grecian horse, at 
hearing such a doctrine associated with his respectable 
name. I was not aware, when writing to Paris, that 
this worthy Professor, whose lectures I long attended, 
was included in these audacious claims ; but after the 
specimens I have given of the accuracy of the foreign 
correspondence of the " Homoeopathic Examiner," any 
further information I might obtain would seem so su- 
perfluous as hardly to be worth the postage. 

Homoeopathy may be said, then, to be in a suffi- 
ciently miserable condition in Paris. Yet there lives, 
and there has lived for years, the illustrious Samuel 
Hahnemann, who himself assured my correspondent 
that no place offered the advantages of Paris in its 
investigation, by reason of the attention there paid to 
it. 

In England, it appears by the statement of Dr. 
Curie in October, 1839, about eight years after its in- 
troduction into the country, that there were eighteen 
Homoeopathic physicians in the United Kingdom, of 
whom only three were to be found out of London, and 
that many of these practised Homoeopathy in secret. 

It will be seen, therefore, that, according to the re- 
cent statement of one of its leading English advocates, 



HOMCEOPATHY AND ITS KINDRED DELUSIONS. 93 

Homoeopathy had obtained not quite half as many- 
practical disciples in England as Perkinism could show 
for itself in a somewhat less period from the time of 
its first promulgation in that country. 

Dr. Curie's letter, dated London, October 30, 1839, 
says there is " one in Dublin, Dr. Luther ; at Glas- 
gow, Dr. Scott." The ' ; distinguished " Croserio writes 
from Paris, dating October 20, 1839, " On the other 
hand, Homoeopathy is commencing to make an inroad 
into England by the way of Ireland. At Dublin, dis- 
tinguished physicians have already embraced the new 
system, and a great part of the nobility and gentry 
of that city have emancipated themselves from the 
English fashion and professional authority." 

But the Marquis of Anglesea and Sir Edward Lyt- 
ton Bulwer patronize Homoeopathy ; the Queen Dow- 
ager Adelaide has been treated by a Homoeopathic 
physician. " Jarley is the delight of the nobility and 
gentry." " The Royal Family are the patrons of Jar- 
ley." 

Let me ask if a Marquis and a Knight are better 
than two Lords, and if the Dowager of Royalty is 
better than Royalty itself, all of which illustrious dig- 
nities were claimed in behalf of Benjamin Douglass 
Perkins ? 

But if the balance is thought too evenly suspended 
in this case, another instance can be given in which 
the evidence of British noblemen and their ladies is 
shown to be as valuable in establishing the character 
of a medical man or doctrine, as would be the testi- 
mony of the Marquis of Waterford concerning the 
present condition and prospects of missionary enter- 
prise. I have before me an octavo volume of more 
than four hundred pages, in which, among much sim- 



94 MEDICAL ESSAYS. 

ilar matter, I find highly commendatory letters from 
the Marchioness of Ormond, Lady Harriot Kava- 
nagh, the Countess of Buckinghamshire, the Right 
Hon. Viscount Ingestre, M. P., and the Most Noble, 
the Marquis of Sligo, — all addressed to " John St. 
John Long, Esq.," a wretched charlatan, twice tried 
for, and once convicted of, manslaughter at the Old 
Bailey. 

This poor creature, too, like all of his tribe, speaks 
of the medical profession as a great confederation of 
bigoted monopolists. He, too, says that " If an inno- 
vator should appear, holding out hope to those in 
despair, and curing disorders which the faculty have 
recorded as irremediable, he is at once, and without 
inquiry, denounced as an empiric and an impostor." 
He, too, cites the inevitable names of Galileo and 
Harvey, and refers to the feelings excited by the great 
discovery of Jenner. From the treatment of the great 
astronomer who was visited with the punishment of 
other heretics by the ecclesiastical authorities of a 
Catholic country some centuries since, there is no very 
direct inference to be drawn to the medical profession 
of the present time. His name should be babbled no 
longer, after having been placarded for the hundredth 
time in the pages of St. John Long. But if we arc 
doomed to see constant reference to the names of Har- 
vey and Jenner in every worthless pamphlet contain- 
ing the prospectus of some new trick upon the public, 
let us, once for all, stare the facts in the face, and see 
how the discoveries of these great men were actually 
received by the medical profession. 

In 1628, Harvey published his first work upon the 
circulation. His doctrines were a complete revolution 
of the prevailing opinions of all antiquity. They im- 



HOMCEOPATHY AND ITS KINDRED DELUSIONS. 95 

mediately found both champions and opponents ; of 
which last, one only, Riolanus, seemed to Harvey 
worthy of an answer, on account of his " rank, fame, 
and learning." Controversy in science, as in religion, 
was not, in those days, carried on with all the courtesy 
which our present habits demand, and it is possible 
that some hard words may have been applied to Har- 
vey, as it is very certain that he used the most con- 
temptuous expressions towards others. 

Harvey declares in his second letter to Riolanus, 
" Since the first discovery of the circulation, hardly a 
day, or a moment, has passed without my hearing it 
both well and ill spoken of ; some attack it with great 
hostility, others defend it with high encomiums ; one 
"party believe that I have abundantly proved the truth 
of the doctrine against all the weight of opposing ar- 
guments, by experiments, observations, and dissec- 
tions ; others think it not yet sufficiently cleared up, 
and free from objections." Two really eminent Pro- 
fessors, Plempius of Louvain, and Walseus of Ley- 
den, were among its early advocates. 

The opinions sanctioned by the authority of long 
ages, and the names of Hippocrates and Galen, dis- 
solved away, gradually, but certainly, before the dem- 
onstrations of Harvey. Twenty-four years after the 
publication of his first work, and six years before his 
death, his bust in marble was placed in the Hall of 
the College of Physicians, with a suitable inscription 
recording his discoveries. 

Two years after this he was unanimously invited to 
accept the Presidency of that body ; and he lived to 
see his doctrine established, and all reputable opposi- 
tion withdrawn. 

There were many circumstances connected with the 



96 MEDICAL ESSAYS. 

discovery of Dr. Jenner which were of a nature to ex- 
cite repugnance and opposition. The practice of in- 
oculation for the small-pox had already disarmed that 
disease of many of its terrors. The introduction of a 
contagious disease from a brute creature into the hu- 
man system naturally struck the public mind with a 
sensation of disgust and apprehension, and a part of 
the medical public may have shared these feelings. 
I find that Jenner' s discovery of vaccination was made 
public in June, 1798. In July of the same year the 
celebrated surgeon, Mr. Cline, vaccinated a child with 
virus received from Dr. Jenner, and in communicating 
the success of this experiment, he mentions that Dr. 
Lister, formerly of the Small-Pox Hospital, and him- 
self, are convinced of the efficacy of the cow-pox. In 
November of the same year, Dr. Pearson published 
his " Inquiry," containing the testimony of numerous 
practitioners in different parts of the kingdom, to the 
efficacy of the practice. Dr. IIaygartii, who was so 
conspicuous in exposing the follies of Perkinism, was 
among the very earliest to express his opinion in favor 
of vaccination. In 1801, Dr. Lettsom mentions the 
circumstance " as being to the honor of the medical 
professors, that they have very generally encouraged 
this salutary practice, although it is certainly calcu- 
lated to lessen their pecuniary advantages oy its ten- 
dency to extirpate a fertile source of professional prac- 
tice." 

In the same year the Medical Committee of Paris 
spoke of vaccination in a public letter, as " the most 
brilliant and most important discovery of the eight- 
eenth century." The Directors of a Society for the 
Extermination of the Small-Pox, in a Report dated 
October 1st, 1807, " congratulate the public on the 



HOMOEOPATHY AND ITS KINDRED DELUSIONS. 97 

very favorable opinion which the Royal College of 
Physicians of London, after a most minute and labo- 
rious investigation made by the command of his Maj- 
esty, have a second time expressed on the subject of 
vaccination, in their Report laid before the House of 
Commons, in the last session of Parliament ; in conse- 
quence of which the sum of twenty thousand pounds 
was voted to Dr. Jenner, as a remuneration for his 
discovery, in addition to ten thousand pounds before 
granted." (In June, 1802.) 

These and similar accusations, so often brought up 
against the Medical Profession, are only one mode in 
which is manifested a spirit of opposition not merely 
to medical science, but to all science, and to all sound 
knowledge. It is a spirit which neither understands 
itself nor the object at which it is aiming. It gropes 
among the loose records of the past, and the floating 
fables of the moment, to glean a few truths or false- 
hoods tending to prove, if they prove anything, that 
the persons who have passed their lives in the study 
of a branch of knowledge the very essence of which 
must always consist in long and accurate observation, 
are less competent to judge of new doctrines in their 
own department than the rest of the community. It 
belongs to the clown in society, the destructive in pol- 
itics, and the rogue in practice. 

The name of Harvey, whose great discovery was the 
legitimate result of his severe training and patient 
study, should be mentioned only to check the preten- 
sions of presumptuous ignorance. The example of 
Jenner, who gave his inestimable secret, the result of 
twenty-two years of experiment and researches, un- 
purchased, to the public, — when, as was said in Par- 
liament, he might have made a hundred thousand 



98 MEDICAL ESSAYS. 

pounds by it as well as any smaller sum, — should be 
referred to only to rebuke the selfish venders of secrev 
remedies, among whom his early history obliges us re- 
luctantly to record Samuel Hahnemann. Those who 
speak of the great body of physicians as if they were 
united in a league to support the superannuated no- 
tions of the past against the progress of improvement, 
have read the history of medicine to little purpose. 
The prevalent failing of this profession has been, on 
the contrary, to lend a too credulous ear to ambitious 
and plausible innovators. If at the present time ten 
years of public notoriety have passed over any doctrine 
professing to be of importance in medical science, and 
if it has not succeeded in raising up a powerful body 
of able, learned, and ingenious advocates for its claims, 
the fault must be in the doctrine and not in the medi- 
cal profession. 

Homoeopathy has had a still more extended period 
of trial than this, and we have seen with what results. 
It only remains to throw out a few conjectures as to 
the particular manner in which it is to break up and 
disappear. 

1. The confidence of the few believers in this delu- 
sion will never survive the loss of friends who may 
die of any acute disease, under a treatment such as 
that prescribed by Homoeopathy. It is doubtfu] how 
far cases of this kind will be trusted to its tender mer- 
cies, but wherever it acquires any considerable foot- 
hold, such cases must come, and with them the ruin of 
those who practise it, should any highly valued life be 
thus sacrificed. 

2. After its novelty has worn out, the ardent and 
capricious individuals who constitute the most promi- 
nent class of its patrons will return to visible doses, 
were it only for the sake of a change. 



HOMOEOPATHY AND ITS KINDKED DELUSIONS. 99 

3. The Semi-Homoeopathic practitioner will gradu- 
ally withdraw from the rotten half of his business and 
try to make the public forget his connection with it. 

4. The ultra Homoeopathist will either recant and 
try to rejoin the medical profession ; or he will em- 
brace some newer and if possible equally extravagant 
doctrine ; or he will stick to his colors and go down 
with his sinking doctrine. Very few will pursue the 
course last mentioned. 

A single fact may serve to point out in what direc- 
tion there will probably be a movement of the dissolv- 
ing atoms of Homoeopathy. On the 13th page of the 
too frequently cited Manifesto of the " Examiner " I 
read the following stately paragraph : — ■ 

" Bigelius, M. D., physician to the Emperor of 
Russia, whose elevated reputation is well known in 
Europe, has been an acknowledged advocate of Hah- 
nemann's doctrines for several years. He abandoned 
Allopathia for Homoeopathia." The date of this state- 
ment is January, 1840. I find on looking at the book- 
sellers' catalogues that one Bigel, or Bigelius, to speak 
more classically, has been at various times publishing 
Homoeopathic books for some years. 

Again, on looking into the " Encyclographie des 
Sciences Medieales " for April, 1840, I find a work 
entitled " Manual of Hydrosudopathy, or the Treat- 
ment of Diseases by Cold Water, etc., etc., by Dr. Bi- 
gel, Physician of the School of Strasburg, Member of 
the Medico-Chirurgical Institute of Naples, of the 
Academy of St. Petersburg, — Assessor of the Col- 
lege of the Empire of Russia, Physician of his late 
Imperial Highness the Grand Duke Constantine, 
Chevalier of the Legion of Honor, etc." Hydrosu- 
dopathy or Hydropathy, as it is sometimes called, is a 



100 MEDICAL ESSAYS. 

new medical doctrine or practice which has sprung up 
in Germany since Homoeopathy, which it bids fair to 
drive out of the market, if, as Dr. Bigel says, fourteen 
physicians afflicted with diseases which defied them- 
selves and their colleagues came to Graefenberg, in 
the year 1836 alone, and were cured. Now Dr. Bigel, 
"whose elevated reputation is well known in Europe," 
writes as follows : " The reader will not fail to see in 
this defence of the curative method of Graefenberg a 
profession of medical faith, and he will be correct in 
so doing." And his work closes with the following 
sentence, worthy of so distinguished an individual: 
" We believe, with religion, that the water of baptism 
purines the soul from its original sin ; let us believe 
also, with experience, that it is for our corporeal sins 
the redeemer of the human body." If Bigel, Physi- 
cian to the late Grand Duke Constantino, is identical 
with Bigel whom the " Examiner " calls Physician to 
the Emperor of Russia, it appears that he is now ac- 
tively engaged in throwing cold water at once upon his 
patients and the future prospects of Homoeopathy. 

If, as must be admitted, no one of Hahnemann's 
doctrines is received with tolerable unanimity among 
his disciples, except the central axiom, Similia siinil- 
thus curantur ; if this axiom itself relies mainly for 
its support upon the folly and trickery of Hahnemann, 
what can we think of those who announce themselves 
ready to relinquish all the accumulated treasures of 
our art, to trifle with life upon the strength of these 
fantastic theories ? What shall we think of jDrofessed 
practitioners of medicine, if, in the words of Jahr, 
" from ignorance, for their personal convenience, or 
through charlatanism, they treat their patients one 



HOMCEOPATHY AND ITS KINDRED DELUSIONS. 101 

day Homoeopathic ally and the next Allopathically ; " 
if they parade their pretended new science before the 
unguarded portion of the community ; if they suffer 
their names to be coupled with it wherever it may 
gain a credulous patient ; and deny all responsibility 
for its character, refuse all argument for its doctrines, 
allege no palliation for the ignorance and deception 
interwoven with every thread of its flimsy tissue, when 
they are questioned by those competent to judge and 
entitled to an answer ? 

Such is the pretended science of Homoeopathy, to 
which you are asked to trust your lives and the lives 
of those dearest to you. A mingled mass of perverse 
ingenuity, of tinsel erudition, of imbecile credulity, 
and of artful misrepresentation, too often mingled in 
practice, if we may trust the authority of its founder, 
with heartless and shameless imposition. Because it 
is suffered so often to appeal unanswered to the pub- 
lic, because it has its journals, its patrons, its apostles, 
some are weak enough to suppose it can escape the 
inevitable doom of utter disgrace and oblivion. Not 
many years can pass away before the same curiosity 
excited by one of Perkins's Tractors will be awakened 
at the sight of one of the Infinitesimal Globules. If 
it should claim a longer existence, it can only be by 
falling into the hands of the sordid wretches who wring 
their bread from the cold grasp of disease and death 
in the hovels of ignorant poverty. 

As one humble member of a profession which for 
more than two thousand years has devoted itself to 
the pursuit of the best earthly interests of mankind, 
always assailed and insulted from without by such as 
are ignorant of its infinite perplexities and labors, 
always striving in unequal contest with the hundred- 



102 MEDICAL ESSAYS. 

armed giant who walks in the noonday, and sleeps not 
in the midnight, yet still toiling, not merely for itself 
and the present moment, but for the race and the fu- 
ture, I have lifted my voice against this lifeless delu- 
sion, rolling its shapeless bulk into the path of a noble 
science it is too weak to strike, or to injure. 



II. 

THE CONTAGIOUSNESS OF PUERPERAL FEVER. 



THE POINT AT ISSUE. 



THE AFFIRMATIVE. 



" The disease known as Puerperal Fever is so far contagious as to be 
frequently carried from patient to patient by physicians and nurses." — 
0. W. Holmes, 1843. 

THE NEGATIVE. 

"The result of the whole discussion will, I trust, serve, not only to exalt 
your views of the value and dignity of our profession, but to divest your 
minds of the overpowering dread that you can ever become, especially to 
woman, under the extremely interesting circumstances of gestation and 
parturition, the minister of evil ; that you can ever convey, in any possi- 
ble manner, a horrible virus, so destructive in its effects, and so mysterious 
in its operations as that attributed to puerperal fever." — Professor Hodge, 
1852. 

"I prefer to attribute them to accident, or Providence, of which I can 
form a conception, rather than to a contagion of which I cannot form any 
clear idea, at least as to this particular malady." — Professor Meigs, 1852. 

"... in the propagation of which they have no more to do, than 
with the propagation of cholera from Jessore to San Francisco, and from 
Mauritius to St. Petersburg." — Professor Meigs, 1854. 



"I arrived at that certainty in the matter, that I could venture to fore- 
tell what women would be affected with the disease, upon hearing by what 
midwife they were to be delivered, or by what nurse they were to be at- 
tended, during their lying-in ; and, almost in every instance, my predic- 
tion was verified." — Gordon, 1795. 

a Printed in 1843 ; reprinted with additions, 1856. 



104 MEDICAL ESSAYS. 

"A certain number of deaths is caused every year by the contagion of 
puerperal fever, communicated by the nurses and medical attendants." — 
FatT, in Fifth Annual Report of Registrar-General of England, 1843. 

"... boards of health, if such exist, or, without them, the medical in- 
stitutions of a country, should have the power of coercing, or of indicting 
some kind of punishment on those who recklessly go from cases of puer- 
peral fevers to parturient or puerperal females, without using due precau- 
tion : and who, having been shown the risk, criminally encounter it, and 
convey pestilence and death to the persons they are employed to aid in I lie 
most interesting and suffering period of female existence." — Copland's 
Medical Dictionary, Art. Puerperal States and Diseases, 1802. 

"We conceive it unnecessary to go into detail to prove the contagious 
nature of this disease, as there are few, if any, American practitioners who 
do not believe in this doctrine." — Dr. Lee, in Additions to Article last 
cited. 



[Introductory note.] It happened, some years 
ago, that a discussion arose in a Medical Society of 
which I was a member, involving the subject of a cer- 
tain supposed canst; of disease, about which something 
was known, a good deal suspected, and not a little 
feared. The discussion was suggested by a case, re- 
ported at the preceding meeting, of a physician who 
made an examination of the body of a patient who had 
died with puerperal fever, and who himself died in 
less than a week, apparently in consequence of a 
wound received at the examination, having attended 
several women in confinement in the mean time, all of 
whom, as it was alleged, were attacked with puerperal 
fever. 

Whatever apprehensions and beliefs were enter- 
tained, it was plain that a fuller knowledge of the 
facts relating to the subject would be acceptable to all 
present. I therefore felt that it would be doing a 
good service to look into the best records I could find, 
and inquire of the most trustworthy practitioners I 



THE CONTAGIOUSNESS OF PUERPERAL FEVER. 105 

knew, to learn what experience had to teach in the 
matter, and arrived at the results contained in the 
following- pages. 

The Essay was read before the Boston Society for 
Medical Improvement, and, at the request of the So- 
ciety, printed in the " New England Quarterly Jour- 
nal of Medicine and Surgery " for April, 1843. As 
this Journal never obtained a large circulation, and 
ceased to be published after a year's existence, and 
as the few copies * I had struck off separately were 
soon lost sight of among the friends to whom they 
were sent, the Essay can hardly be said to have been 
fully brought before the Profession. 

The subject of this Paper has the same profound 
interest for me at the present moment as it had when 
I was first collecting* the terrible evidence out of 
which, as it seems to me, the commonest exercise of 
reason could not help shaping the truth it involved. 
It is not merely on account of the bearing of the ques- 
tion, — if there is a question, — on all that is most 
sacred in human life and happiness, that the subject 
cannot lose its interest. It is because it seems evident 
that a fair statement of the facts must produce its 
proper influence on a very large proportion of well- 
constituted and unprejudiced minds. Individuals may, 
here and there, resist the practical bearing of the evi- 
dence on their own feelings or interests ; some may 
fail to see its meaning, as some persons may be found 
who cannot tell red from green ; but I cannot doubt 
that most readers will be satisfied and convinced, to 
loathing, long before they have finished the dark obit- 
uary calendar laid before them. 

I do not know that I shall ever again have so good 
an opportunity of being useful as was granted me by 



106 MEDICAL ESSAYS. 

the raising of the question which produced this Essay. 
For I have abundant evidence that it has made many 
practitioners more cautious in their relations with 
puerperal females, and I have no doubt it will do so 
still, if it has a chance of being read, though it should 
call out a hundred counterblasts, proving to the satis- 
faction of their authors that it proved nothing. And 
for my part, I had rather rescue one mother from be- 
ing poisoned by her attendant, than claim to have 
saved forty out of fifty patients to whom I had car- 
ried the disease. Thus, I am willing to avail myself of 
any hint coming from without to offer this paper once 
more to the press. The occasion has presented itself, as 
will be seen, in a convenient if not in a flattering form. 

I send this Essay again to the Medical Profes- 
sion, without the change of a word or syllable. I 
find, on reviewing it, that it anticipates and eliminates 
those secondary questions which cannot be entertained 
for a moment until the one great point of fact is per- 
emptorily settled. In its very statement of the doc- 
trine maintained it avoids all discussion of the nature 
of the disease "known as puerperal fever " and all 
the somewhat stale philology of the word contagion. 
It mentions, fairly enough, the names of sceptics, or 
unbelievers as to the reality of personal transmission ; 
of Dewees, of Tonnelle, of Duges, of Baudelocque, 
and others ; of course, not including those whose 
works were then unwritten or unpublished ; nor enu- 
merating all the Continental writers who, in ignorance 
of the great mass of evidence accumulated by British 
practitioners, could hardly be called well informed on 
this subject. It meets all the array of negative cases, 
— those in which disease did not follow exposure, — 



THE CONTAGIOUSNESS OF PUERPERAL FEVER. 107 

by the striking example of small-pox, which, although 
one of the most contagious of diseases, is subject to 
the most remarkable irregularities and seeming ca- 
prices in its transmission. It makes full allowance for 
other causes besides personal transmission, especially 
for epidemic influences. It allows for the possibility 
of different modes of conveyance of the destructive 
principle. It recognizes and supports the belief that 
a series of cases may originate from a single primitive 
source which affects each new patient in turn ; and es- 
pecially from cases of Erysipelas. It does not under- 
take to discuss the theoretical aspect of the subject ; 
that is a secondary matter of consideration. Where 
facts are numerous, and unquestionable, and unequiv- 
ocal in their significance, theory must follow them as 
it best may, keeping time with their step, and not go 
before them, marching to the sound of its own drum 
and trumpet. Having thus narrowed its area to a lim- 
ited practical platform of discussion, a matter of life 
and death, and not of phrases or theories, it covers 
every inch of it with a mass of evidence which I con- 
ceive a Committee of Husbands, who can count coinci- 
dences and draw conclusions as well as a Synod of 
Accoucheurs, would justly consider as affording ample 
reasons for an unceremonious dismissal of a practi- 
tioner (if it is conceivable that such a step could be 
waited for), after five or six funerals had marked the 
path of his daily visits, while other practitioners were 
not thus escorted. To the Profession, therefore, I 
submit the paper in its original form, and leave it to 
take care of itself. 

To the Medical Students, into whose hands this 
Essay may fall, some words of introduction may be 



108 MEDICAL ESSAYS. 

appropriate, and perhaps, to a small number of them, 
necessary. There are some among them who, from 
youth, or want of training, are easily bewildered and 
confused in any conflict of opinions into which their 
studies lead them. They are liable to lose sight of 
the main question in collateral issues, and to be run 
away with by suggestive speculations. They confound 
belief with evidence, often trusting the first because it 
is expressed with energy, and slighting the latter be- 
cause it is calm and unimpassioned. They are not 
satisfied with proof ; they cannot believe a point is 
settled so long as everybody is not silenced. They 
have not learned that error is got out of the minds 
that cherish it, as the taenia is removed from the body, 
one joint, or a few joints at a time, for the most part, 
rarely the whole evil at once. They naturally have 
faith in their instructors, turning to them for truth, 
and taking what they may choose to give them ; babes 
in knowledge, not yet able to tell the breast from the 
bottle, pumping away for the milk of truth at all that 
offers, were it nothing better than a Professor's shriv- 
elled forefinger. 

In the earliest and embryonic stage of professional 
development, any violent impression on the instruct- 
or's mind is apt to be followed by some lasting effect 
on that of the pupil. No mother's mark is more per- 
manent than the mental nam and moles, and excres- 
cences, and mutilations, that students carry with them 
out of the lecture- room, if once the teeming intellect 
which nourishes theirs has been scared from its pro- 
priety by any misshapen fantasy. Even an impatient 
or petulant expression, which to a philosopher would 
be a mere index of the low state of amiability of the 
speaker at the moment of its utterance, may pass into 



THE CONTAGIOUSNESS OF PUERPERAL FEVER. 109 

the young mind as an element of its future constitu- 
tion, to injure its temper or corrupt its judgment. It 
is a duty, therefore, which we owe to this younger 
class of students, to clear any important truth which 
may have been rendered questionable in their minds 
by such language, or any truth-teller against whom 
they may have been prejudiced by hasty epithets, from 
the impressions such words have left. Until this is 
done, they are not ready for the question, where there 
is a question, for them to decide. Even if we ourselves 
are the subjects of the prejudice, there seems to be 
no impropriety in showing that this prejudice is local 
or personal, and not an acknowledged conviction with 
the public at large. It may be necessary to break 
through our usual habits of reserve to do this, but 
this is the fault of the position in which others have 
placed us. 

Two widely-known and highly-esteemed practition- 
ers, Professors in two of the largest Medical Schools 
of the Union, teaching the branch of art which in- 
cludes the Diseases of Women, and therefore speak- 
ing with authority; addressing in their lectures and 
printed publications large numbers of young men, 
many of them in the tender est immaturity of knowl- 
edge, have recently taken ground in a formal way 
against the doctrine maintained in this paper. a The 

a On the Nan- Contagions Character of Puerperal Fever : An 
Introductory Lecture. By Hugh L. Hodge, M. D., Professor 
of Obstetrics in the University of Pennsylvania. Delivered 
Monday, October 11, 1852. Philadelphia, 1852. 

On the Nature, Signs, and Treatment of Childbed Fevers : in 
a Series of Letters addressed to the Students of his Class. By 
Charles D. Meigs, M. I)., Professor of Midwifery and the Dis- 
eases of Women and Children in Jefferson Medical College, 
Philadelphia, etc., etc. Philadelphia, 1854. Letter VI. 



110 MEDICAL ESSAYS. 

first of the two publications, Dr. Hodge's Lecture, 
while its theoretical considerations and negative ex- 
periences do not seem to me to require any further 
notice than such as lay ready for them in my Essay 
written long before, is, I am pleased to say, unobjec- 
tionable in tone and language, and may be read with- 
out offence. 

This can hardly be said of the chapter of Dr. 
Meigs's volume which treats of Contagion in Childbed 
Fever. There are expressions used in it which might 
well put a stop to all scientific discussions, were they 
to form the current coin in our exchange of opinions. 
I leave the " very young gentlemen," whose careful 
expositions of the results of practice in more than six 
thousand cases are characterized as " the jejune and 
fizenless dreamings of sophomore writers," to the sym- 
pathies of those u dear young friends," and "dear 
young gentlemen," who will judge how much to value 
their instructor's counsel to think for themselves, know- 
ing what they are to expect if they happen not to 
think as lie does. 

One unpalatable expression I suppose the laws of 
construction oblige me to appropriate to myself, as 
my reward for a certain amount of labor bestowed on 
the investigation of a very important question of evi- 
dence, and a statement of my own practical conclu- 
sions. I take no offence, and attempt no retort. No 
man makes a quarrel with me over the counterpane 
that covers a mother, with her new-born infant at her 
breast. There is no epithet in the vocabulary of slight 
and sarcasm that can reach my personal sensibilities in 
such a controversy. Only just so far as a disrespect- 
ful phrase may turn the student aside from the exami- 
nation of the evidence, by discrediting or dishonoring 
the witness, does it call for any word of notice. 



THE CONTAGIOUSNESS OF PUERPERAL FEVER. Ill 

I appeal from the disparaging language by which 
the Professor in the Jefferson School of Philadelphia 
would dispose of my claims to be listened to. I appeal, 
not to the vote of the Society for Medical Improve- 
ment, although this was an unusual evidence of inter- 
est in the paper in question, for it was a vote passed 
among my own townsmen ; nor to the opinion of any 
American, for none know better than the Professors 
in the great Schools of Philadelphia how cheaply the 
praise of native contemporary criticism is obtained. 
I appeal to the recorded opinions of those whom I do 
not know, and who do not know me, nor care for me, 
except for the truth that I may have uttered ; to Cop- 
land, in his " Medical Dictionary," who has spoken 
of my Essay in phrases to which the pamphlets of 
American " scribblers " are selcfom used from Euro- 
pean authorities ; to Ranisbotham, whose compendious 
eulogy is all that self-love could ask ; to the " Fifth 
Annual Report " of the Registrar-General of Eng- 
land, in which the second-hand abstract of my Essay 
figures largely, and not without favorable comment, 
in an important appended paper. These testimonies, 
half forgotten until this circumstance recalled them, 
are dragged into the light, not in a paroxysm of vanity, 
but to show that there may be food for thought in the 
small pamphlet which the Philadelphia Teacher treats 
so lightly. They were at least unsought for, and 
would never have been proclaimed but for the sake of 
securing the privilege of a decent and unprejudiced 
hearing. 

I will take it for granted that they have so far 
counterpoised the depreciating language of my fellow- 
countryman and fellow-teacher as to gain me a reader 
here and there among the youthful class of students 



112 MEDICAL ESSAYS. 

I am now addressing. It is only for their sake that I 
think it necessary to analyze, or explain, or illustrate, 
or corroborate any portion of the following Essay. 
But I know that nothing can be made too plain for 
beginners ; and as I do not expect the practitioner, or 
even the more mature student, to take the trouble to 
follow me through an Introduction which I consider 
wholly unnecessary and superfluous for them, I shall 
not hesitate to stoop to the most elementary simplicity 
for the benefit of the younger student. I do this more 
willingly because it affords a good opportunity, as it 
seems to me, of exercising the untrained mind in that 
medical logic which does not seem to have been either 
taught or practised in our schools of late, to the ex- 
tent that might be desired. 

I will now exhibit, in a series of propositions re- 
duced to their simplest expression, the same essential 
statements and conclusions as are contained in the 
Essay, with such commentaries and explanations as 
may be profitable to the inexperienced class of readers 
addressed. 

I. It has been long believed, by many competent 
observers, that Puerperal Fever (so called) is some- 
times carried from patient to patient by medical as- 
sistants. 

II. The express object of this Essay is to prove that 
it is so carried. 

III. In order to prove this point, it is not necessary 
to consult any medical theorist as to whether or not 
it is consistent with his preconceived notions that such 
a mode of transfer should exist. 

IV. If the medical theorist insists on being con- 
sulted, and we see fit to indulge him, he cannot be al- 



THE CONTAGIOUSNESS OF PUERPERAL FEVER. 113 

lowed to assume that the alleged laws of contagion, 
deduced from observation in other diseases, shall be 
cited to disprove the alleged laws deduced from ob- 
servation in this. Science would never make progress 
under such conditions. Neither the long incubation 
of hydrophobia, nor the protecting power of vaccina- 
tion, would ever have been admitted, if the results of 
observation in these affections had been rejected as 
contradictory to the previously ascertained laws of 
contagion. 

V. The disease in question is not a common one ; 
producing, on the average, about three deaths in a 
thousand births, according to the English Registration 
returns which I have examined. 

VI. When an unusually large number of cases of 
this disease occur about the same time, it is inferred, 
therefore, that there exists some special cause for this 
increased frequency. If the disease prevails exten- 
sively over a wide region of country, it is attributed 
without dispute to an epidemic influence. If it pre- 
vails in a single locality, as in a hospital, and not else- 
where, this is considered proof that some local cause 
is there active in its production. 

VII. When a large number of cases of this disease 
occur in rapid succession, in one individual's ordinary 
practice, and few or none elsewhere, these cases ap- 
pearing in scattered localities, in patients of the same 
average condition as those who escape under the care 
of others, there is the same reason for connecting the 
cause of the disease with the person in this instance, 
as with the place in that last mentioned. 

VIII. Many series of cases, answering to these con- 
ditions, are given in this Essay, and many others will 



114 MEDICAL ESSAYS. 

be referred to which have occurred since it was writ- 
ten. 

IX. The alleged results of observation may be set 
aside ; first, because the so-called facts are in their 
own nature equivocal ; secondly, because they stand 
on insufficient authority ; thirdly, because they are not 
sufficiently numerous. But, in this case, the disease 
is one of striking and well-marked character ; the wit- 
nesses are experts, interested in denying and disbe- 
lieving the facts ; the number of consecutive cases in 
many instances frightful, and the number of series of 
cases such that I have no room for many of them ex- 
cept by mere reference. 

X. These results of observation, being admitted, 
may, we will suppose, be interpreted in different meth- 
ods. Thus the coincidences may be considered the 
effect of eli a nee. I have had the chances calculated 
by a competent person, that a given practitioner, A., 
shall have sixteen fatal cases in a month, on the fol- 
lowing data : A. to average attendance upon two hun- 
dred and fifty births in a year ; three deaths in one 
thousand births to be assumed as the average from 
puerperal fever ; no epidemic to be at the time pre- 
vailing. It follows, from the answer given me, that if 
we suppose every one of the five hundred thousand 
annual births of England to have been recorded dur- 
ing the last half-century, there would not be one 
chance in a million million million millions that one 
such series should be noted. No possible fractional 
error in this calculation can render the chance a work- 
ing probability. Applied to dozens of series of vari- 
ous lengths, it is obviously an absurdity. Chance, 
therefore, is out of the question as an explanation of 
the admitted coincidences. 



THE CONTAGIOUSNESS OF PUERPERAL FEVER. 115 

XI. There is, therefore, some relation of cause and 
effect between the physician's presence and the pa- 
tient's disease. 

XII. Until it is proved to what removable condi- 
tion attaching to the attendant the disease is owing, 
he is bound to stay away from his patients so soon as 
he finds himself singled out to be tracked by the dis- 
ease. How long, and with what other precautions, I 
have suggested, without dictating, at the close of my 
Essay. If the physician does not at once act on any 
reasonable suspicion of his being the medium of trans- 
fer, the families where he is engaged, if they are al- 
lowed to know the facts, should decline his services for 
the time. His feelings on the occasion, however in- 
teresting to himself, should not be even named in this 
connection. A physician who talks about ceremony 
and gratitude, and services rendered, and the treat- 
ment he got, surely forgets himself ; it is impossible 
that he should seriously think of these small matters 
where there is even a question whether he may not 
carry disease, and death, and bereavement into any 
one of " his families," as they are sometimes called. 

I will now point out to the young student the mode 
in which he may relieve his mind of any confusion, or 
possibly, if very young, any doubt, which the perusal of 
Dr. Meigs's Sixth Letter may have raised in his mind. 

The most prominent ideas of the Letter are, first, 
that the transmissible nature of puerperal fever ap- 
pears improbable, and, secondly, that it would be very 
inconvenient to the writer. Dr. Woodville, Physician 
to the Small-Pox and Inoculation Hospital in London, 
found it improbable, and exceedingly inconvenient to 
himself, that cow-pox should prevent small-pox ; but 



116 MEDICAL ESSAYS. 

Dr. Jenner took the liberty to prove the fact, notwith- 
standing. 

I will first call the young student's attention to the 
show of negative facts (exposure without subsequent 
disease), of which much seems to be thought. And I 
may at the same time refer him to Dr. Hodge's Lec- 
ture, where he will find the same kind of facts and 
reasoning. Let him now take up Watson's Lectures, 
the good sense and spirit of which have made his book 
a universal favorite, and open to the chapter on Con- 
tinued Fever. He will find a paragraph containing 
the following sentence : " A man might say, ' I was in 
the battle of Waterloo, and saw many men around me 
fall down and die, and it was said that they were struck 
down by musket-balls ; but I know better than that, for 
I was there all the time, and so were many of my 
friends, and we were never hit by any musket-balls. 
Musket-balls, therefore, could not have been the cause 
of the deaths we witnessed.' And if, like contagion, 
they were not palpable to the senses, such a person 
might go on to affirm that no proof existed of there 
being any such thing as musket-balls." Now let the 
student turn back to the chapter on Hydrophobia in 
the same volume. He will find that John Hunter knew 
a case in which, of twenty-one persons bitten, only one 
died of the disease. He will find that one dosr at 
Charenton was bitten at different times by thirty dif- 
ferent mad dogs, and outlived it all. Is there no such 
thing, then, as hydrophobia? Would one take no es- 
pecial precautions if his wife, about to become a mother, 
had been bitten by a rabid animal, because so many 
escape? Or let him look at " Underwood on Diseases 
of Children," a and he will find the case of a young 
a Philadelphia, 1842, p. 2-14, note. 



THE CONTAGIOUSNESS OF PUERPERAL FEVER. 117 

woman who was inoculated eight times in thirty days, 
at the same time attending several children with small- 
pox, and yet was not infected. But seven weeks after- 
wards she took the disease and died. 

It would seem as if the force of this argument could 
hardly fail to be seen, if it were granted that every 
one of these series of cases were so reported as to 
prove that there could have been no transfer of dis- 
ease. There is not one of them so reported, in the 
Lecture or the Letter, as to prove that the disease may 
not have been carried by the practitioner. I strongly 
suspect that it was so carried in some of these cases, 
but from the character of the very imperfect evidence 
the question can never be settled without further dis- 
closures. 

Although the Letter is, as I have implied, principally 
taken up with secondary and collateral questions, and 
might therefore be set aside as in the main irrelevant, 
I am willing, for the student's sake, to touch some of 
these questions briefly, as an illustration of its logical 
character. 

The first thing to be done, as I thought when I 
wrote my Essay, was to throw out all discussions of the 
word contagion, and this I did effectually by the care- 
ful wording of my statement of the subject to be dis- 
cussed. My object was not to settle the etymology or 
definition of a word, but to show that women had often 
died in childbed, poisoned in some way by their medi- 
cal attendants. On the other point, I, at least, have 
no controversy with anybody, and I think the student 
will do well to avoid it in this connection. If I must 
define my position, however, as well as the term in 
question, I am contented with Worcester's definition; 
provided always this avowal do not open another side- 



118 MEDICAL ESSAYS. 

controversy on the merits of his Dictionary, which 
Dr. Meigs has not cited, as compared with Webster's, 
which he has. 

I cannot see the propriety of insisting that all the 
laws of the eruptive fevers must necessarily hold true 
of this peculiar disease of puerperal women. If there 
were any such propriety, the laws of the eruptive 
fevers must at least be stated correctly. It is not true, 
for instance, as Dr. Meigs states, that contagion is " no 
respecter of persons ; " that " it attacks all individuals 
alike." To give one example : Dr. Gregory, of the 
Small-Pox Hospital, who ought to know, says that per- 
sons pass through life apparently insensible to or un- 
susceptible of the small-pox virus, and that the same 
persons do not take the vaccine disease. 

As to the short time of incubation, of which so 
much is made, we have no right to decide beforehand 
whether it shall be long or short, in the cases we are 
considering. A dissection wound may produce symp- 
toms of poisoning in six hours ; the bite of a rabid 
animal may take as many months. 

After the student has read the case in Dr. Meigs's 
136th paragraph, and the following one, in which he 
exclaims against the idea of contagion, because the 
patient, delivered on the 26th of December, was at- 
tacked in twenty-four hours, and died on the third day, 
let him read what happened at the " Black Assizes " 
of 1577 and 1750. In the first case, six hundred per- 
sons sickened the same night of the exposure, and 
three hundred more in three days." Of those attacked 
in the latter year, the exposure being on the 11th 
of May, Alderman Lambert died on the 13th, Under- 
SherifT Cox on the 14th, and many of note before the 
a Elliotsou's Practice, p. 298. 



THE CONTAGIOUSNESS OF PUERPERAL FEVER. 119 

20th.° But these are old stories. Let the student 
listen then to Dr. Gerhard, whose reputation as a 
cautious observer he may be supposed to know. " The 
nurse was shaving a man, who died in a few hours 
after his entrance ; he inhaled his breath, which had 
a nauseous taste, and in an hour afterwards was taken 
with nausea, cephalalgia, and singing of the ears. 
From that moment the attack began, and assumed a 
severe character. The assistant was supporting an- 
other patient, who died soon afterwards ; he felt the 
pungent heat upon his skin, and was taken immediately 
with the symptoms of typhus." b It is by notes of 
cases, rather than notes of admiration, that we must be 
guided, when we study the Revised Statutes of Nature, 
as laid down from the curule chairs of Medicine. 

Let the student read Dr. Meigs's 140th paragraph 
soberly, and then remember, that not only does he 
infer, suspect, and surmise, but he actually asserts 
(page 154), " there was poison in the house," because 
three out of five patients admitted into a ward had 
puerperal fever and died. Have I not as much right 
to draw a positive inference from " Dr. A.'s " seventy 
exclusive cases as he from the three cases in the ward 
of the Dublin Hospital ? All practical medicine, and 
all action in common affairs, is founded on inferences. 
How does Dr. Meigs know that the patients he bled 
in puerperal fever would not have all got well if he 
had not bled them ? 

" You see a man discharge a gun at another ; you 
see the flash, you hear the report, you see the person 
fall a lifeless corpse ; and you infer, from all these 
circumstances, that there was a ball discharged from 

° Rees's Cyc. art. " Contagion." 

* Am. Jour. Med. Sciences, Feb. 1837, p. 299. 



120 MEDICAL ESSAYS. 

the gun, which entered his body and caused his death, 
because such is the usual and natural cause of such 
an effect. But you did not see the ball leave the gun, 
pass through the air, and enter the body of the slain ; 
and your testimony to the fact of killing is, therefore, 
only inferential, — in other words, circumstantial. It 
is possible that no ball was in the gun ; and we infer 
that there was, only because we cannot account for 
death on any other supposition." a 

" The question always comes to this : Is the cir- 
cumstance of intercourse with the sick followed by the 
appearance of the disease in a proportion of cases so 
much greater than any other circumstance common 
to any portion of the inhabitants of the place under 
observation, as to make it inconceivable that the suc- 
cession of cases occurring in persons having that inter- 
course should have been the result of chance ? If so, 
the inference is unavoidable, that that intercourse 
must have acted as a cause of the disease. All obser- 
vations which do not bear strictly on that point are 
irrelevant, and, in the case of an epidemic first ap- 
pearing in a town or district, a succession of tiro cases 
is sometimes sufficient to furnish evidence which, on 
the principle I have stated, is nearly irresistible." b 

Possibly an inexperienced youth may be awe-struck 
by the quotation from Cuvier. These words, or their 
equivalent, are certainly to be found in his Introduc- 
tion. So are the words "top not come down" ! to 
be found in the Bible, and they were as much meant 
for the ladies' head-dresses as the words of Cuvier 
were meant to make clinical observation wait for a 
permit from anybody to look with its eyes and count 

a Chief Justice Gibson, in Am. Law Journal, vol. vi. p. 123. 
6 Dr. Alison. 



THE CONTAGIOUSNESS OF PUERPERAL FEVER. 121 

on its fingers. Let the inquiring youth read the 
whole Introduction, and he will see what they mean. 

I intend no breach of courtesy, but this is a proper 
place to warn the student against skimming the pref- 
aces and introductions of works for mottoes and em- 
bellishments to his thesis. He cannot learn anatomy 
by thrusting an exploring needle into the body. He 
will be very liable to misquote his author's meaning 
while he is picking off his outside sentences. He may 
make as great a blunder as that simple prince who 
praised the conductor of his orchestra for the piece 
just before the overture ; the musician was too good a 
courtier to tell him that it was only the tuning of the 
instruments. 

To the six propositions in the 142d paragraph, and 
the remarks about " specific " diseases, the answer, if 
any is necessary, seems very simple. An inflamma- 
tion of a serous membrane may give rise to secretions 
which act as a poison, whether that be a " specific " 
poison or not, as Dr. Horner has told his young read- 
ers, and as dissectors know too well ; and that poison 
may produce its symptoms in a few hours after the 
system has received it, as any may see in Druitt's 
" Surgery," if they care to look. Puerperal peritonitis 
may produce such a poison, and puerperal women 
may be very sensible to its influences, conveyed by 
contact or exhalation. Whether this is so or not, 
facts alone can determine, and to facts we have had 
recourse to settle it. 

The following statement is made by Dr. Meigs in 
his 142d paragraph, and developed more at length, 
with rhetorical amplifications, in the 134th. " No hu- 
man being, save a pregnant or parturient woman, is 
susceptible to the poison." This statement is wholly 



122 MEDICAL ESSAYS. 

incorrect, as I am sorry to have to point out to a 
Teacher in Dr. Meigs's position. I do not object to the 
erudition which quotes Willis and Fernelius, the last 
of whom was pleasantly said to have " preserved the 
dregs of the Arabs in the honey of his Latinity." 
But I could wish that more modern authorities had not 
been overlooked. On this point, for instance, among 
the numerous facts disproving the statement, the 
" American Journal of Medical Sciences," published 
not far from his lecture-room, would have presented 
him with a respectable catalogue of such cases. Thus 
he might refer to Mr. Storrs's paper " On the Conta- 
gious Effects of Puerperal Fever on the Male Subject ; 
or on Persons not Childbearing " (Jan. 1846), or to 
Dr. Reid's case (April, 1846), or to Dr. Barron's 
statement of the children's dying of peritonitis in an 
epidemic of puerperal fever at the Philadelphia Hos- 
pital (Oct. 1842), or to various instances cited in Dr. 
Kneeland's article (April, 1846). Or, if he would 
have referred to the " New York Journal," he might 
have seen Prof. Austin Flint's cases. Or, if he had 
honored my Essay so far, he might have found strik- 
ing instances of the same kind in the first of the new 
series of cases there reported and elsewhere. I do not 
see the bearing of his proposition, if it were true. 
But it is one of those assertions that fall in a moment 
before a slight examination of the facts ; and I con- 
fess my surprise, that a professor who lectures on the 
Diseases of Women should have ventured to make it. 
Nearly seven pages are devoted to showing that I 
was wrong in saying I would not be " understood to 
imply that there exists a doubt in the mind of any 
well-informed member of the medical profession as to 
the fact that puerperal fever is sometimes communi* 



Continental 
writers 



THE CONTAGIOUSNESS OF PUERPERAL FEVER. 123 

cated from one person to another, both directly and 
indirectly." I will devote seven lines to these seven 
pages, which seven lines, if I may say it without of- 
fence, are, as it seems to me, six more than are strictly 
necessary. 

The following authors are cited as sceptics by Dr. 
Meigs : — 

Dewees. — I cited the same passage. Did not 
know half the facts. Robert Lee. — Believes the dis- 
ease is sometimes communicable by contagion. T<m- 
nelle Baudelocque. — Both cited by 
me. Jacquemier. — Published three 
years after my Essay. Kiwisch. — V not well 
Behindhand in laiowledge of Puerperal | informed on 
Fever." Paul Dubois. — Scanzoni. J this P oint - 6 

The story of Von Busch is of interest and value, 
but there is nothing in it which need perplex the stu- 
dent. It is not pretended that the disease is always, 
or even, it may be, in the majority of cases, carried 
about by attendants ; only that it is so carried in cer- 
tain cases. That it may have local and epidemic 
causes, as well as that depending on personal trans- 
mission, is not disputed. Remember how small-pox 
often disappears from a community in spite of its con- 
tagious character, and the necessary exposure of many 
persons to those suffering from it; in both diseases 
contagion is only one of the coefficients of the disease. 

I have already spoken of the possibility that Dr. 
Meigs may have been the medium of transfer of puer- 
peral fever in some of the cases he has briefly cata- 
logued. Of Dr. R utter 's cases I do not know how to 

• B. Sr F. Med. Rev. Jan. 1842. 

* See Dr. Simpson's Remarks at Meeting of Edin. Med. Chir. 
Soc. {Am. Jour. Oct. 1851.) 



124 MEDICAL ESSAYS. 

speak. I only ask the student to read the facts stated 
by Dr. Condie, as given in my Essay, and say whether 
or not a man should allow his wife to be attended by 
a practitioner in whose hands " scarcely a female that 
has been delivered for weeks past has escaped an at- 
tack," " while no instance of the disease has occurred 
in the patients of any other accoucheur practising- in 
the same district." If I understand Dr. Meigs and 
Dr. Hodge, they would not warn the physician or 
spare the patient under such circumstances. They 
would " go on," if I understand them, not to seven, or 
seventy, only, but to seventy times seven, if they could 
find patients. If this is not what they mean, may we 
respectfully ask them to state what they do mean, to 
their next classes, in the name of humanity, if not of 
science ! 

I might repeat the question asked concerning Dr. 
Rutter's cases, with reference to those reported by Dr. 
Roberton. Perhaps, however, the student would like 
to know the opinion of a person in the habit of work- 
ing at matters of this kind in a practical point of view. 
To satisfy him on this ground, I addressed the follow- 
ing question to the President of one of our principal 
Insurance Companies, leaving Dr. Meigs's book and 
my Essay in his hands at the same time. 

Question. " If such facts as Roberton's cases were 
before you, and the attendant had had ten, or even 
five fatal cases, or three, or tivo even, would you, or 
would you not, if insuring the life of the next patient 
to be taken care of by that attendant, expect an extra 
premium over that of an average case of childbirth ? " 

Answer. " Of course I should require a very large 
extra premium, if I would take the risk at all." 

But I do not choose to add the expressions of indig- 



THE CONTAGIOUSNESS OF PUERPERAL FEVER. 125 

nation which the examination of the facts before him 
called out. I was satisfied from the effect they pro- 
duced on him, that if all the hideous catalogues of 
cases now accumulated were fully brought to the 
knowledge of the public, nothing, since the days of 
Burke and Hare, has raised such a cry of horror as 
would be shrieked in the ears of the Profession. 

Dr. Meigs has elsewhere invoked " Providence " as 
the alternative of accident, to account for the " coin- 
cidences." ("Obstetrics," Phil. 1852, p. 631.) If so, 
Providence either acts through the agency of second- 
ary causes, as in other diseases, or not. If through 
such causes, let us find out what they are, as we try to 
do in other cases. It may be true that offences, or 
diseases, will come, but " woe unto him through whom 
they come," if we catch him in the voluntary or care- 
less act of bringing them! But if Providence does 
not act through secondary causes in this particular 
sphere of etiology, then why does Dr. Meigs take such 
pains to reason so extensively about the laws of con- 
tagion, which, on that supposition, have no more to do 
with this case than with the plague which destroyed 
the people after David had numbered them? Above 
all, what becomes of the theological aspect of the ques- 
tion, when he asserts that a practitioner was u only 
unlucky in meeting with the epidemic cases ? " ( Op. 
cit. p. 633.) We do not deny that the God of battles 
decides the fate of nations ; but we like to have the 
biggest squadrons on our side, and we are particular 
that our soldiers should not only say their prayers, but 
also keep their powder dry. We do not deny the 
agency of Providence in the disaster at Norwalk, but 
we turn off the engineer, and charge the Company five 
thousand dollars apiece for every life that is sacrificed. 



126 MEDICAL ESSAYS. 

Why a grand jury should not bring in a bill against a 
physician who switches off a score of women one after 
the other along his private track, when he knows that 
there is a black gulf at the end of it, down which they 
are to plunge, while the great highway is clear, is more 
than I can answer. It is not by laying the open draw 
to Providence that he is to escape the charge of man- 
slaughter. 

To finish with all these lesser matters of question, 
I am unable to see why a female must necessarily be 
unattended in her confinement, because she declines 
the services of a particular practitioner. In all the 
series of cases mentioned, the death-carrying attend- 
ant was surrounded by others not tracked by disease 
and its consequences. Which, I would ask, is worse, 
— to call in another, even a rival practitioner, or to 
submit an unsuspecting female to a risk which an In- 
surance Company would have nothing to do with? 

I do not expect ever to return to this subject. 
There is a point of mental saturation, beyond which 
argument cannot be forced without breeding impatient, 
if not harsh, feelings towards those who refuse to be 
convinced. If I have so far manifested neither, it is 
well to stop here, and leave the rest to those j'ounger 
friends who may have more stomach for the dregs of 
a stale argument. 

The extent of my prefatory remarks may lead some 
to think that I attach too much importance to my own 
Essay. Others may wonder that I should expend so 
many words upon the two produetions referred to, the 
Letter and the Lecture. I do consider my Essay of 
much importance so long as the doctrine it maintains 
is treated as a question, and so long as any important 



THE CONTAGIOUSNESS OF PUERPERAL FEVER. 127 

part of the defence of that doctrine is thought to rest 
on its evidence or arguments. I cannot treat as in- 
significant any opinions bearing on life, and interests 
dearer than life, proclaimed yearly to hundreds of 
young men, who will carry them to their legitimate 
results in practice. 

The teachings of the two Professors in the great 
schools of Philadelphia are sure to be listened to, not 
only by their immediate pupils, but by the Profession 
at larsfe. I am too much in earnest for either humil- 
ity or vanity, but I do entreat those who hold the keys 
of life and death to listen to me also for this once. 
I ask no personal favor ; but I beg to be heard in be- 
half of the women whose lives are at stake, until some 
stronger voice shall plead for them. 

I trust that I have made the issue perfectly distinct 
and intelligible. And let it be remembered that this 
is no subject to be smoothed over by nicely adjusted 
phrases of half-assent and half-censure divided be- 
tween the parties. The balance must be struck boldly 
and the result declared plainly. If I have' been hasty, 
presumptuous, ill-informed, illogical ; if my array of 
facts means nothing ; if there is no reason for any 
caution in the view of these facts ; let me be told so on 
such authority that I must believe it, and I will be 
silent henceforth, recognizing that my mind is in a 
state of disorganization. If the doctrine I have main- 
tained is a mournful truth ; if to disbelieve it, and to 
practise on this disbelief, and to teach others so to dis- 
believe and practise, is to carry desolation, and to 
charter others to carry it, into confiding families, let 
it be proclaimed as plainly what is to be thought of 
the teachings of those who sneer at the alleged dan- 
gers, and scout the very idea of precaution. Let it be 



128 MEDICAL ESSAYS. 

remembered that persons are nothing in this matter; 
better that twenty pamphleteers should be silenced, or 
as many professors unseated, than that one mother's 
life should be taken. There is no quarrel here be- 
tween men, but there is deadly incompatibility and 
exterminating warfare between doctrines. Coinci- 
dences, meaning nothing, though a man have a mo- 
nopoly of the disease for weeks or months ; or cause 
and effect, the cause being in some way connected 
with the person ; this is the question. If I am wrong, 
let me be put down by such a rebuke as no rash de- 
claimer has received since there has been a public 
opinion in the medical profession of America ; if I am 
right, let doctrines which lead to professional homicide 
be no longer taught from the chairs of those two great 
Institutions. Indifference will not do here ; our Jour- 
nalists and Committees have no right to take up their 
pages with minute anatomy and tediously detailed 
cases, while it is a question whether or not the " black- 
death " of child-bed is to be scattered broadcast by the 
agency of the mother's friend and adviser. Let the 
men who mould opinions look to it ; if there is any 
voluntary blindness, any interested oversight, any cul- 
pable negligence, even, in such a matter, and the facts 
shall reach the public ear ; the pestilence-carrier of 
the lying-in chamber must look to God for pardon, 
for man will never forgive him. 

THE CONTAGIOUSNESS OF PUERPERAL FEVER. 

In collecting, enforcing, and adding to the evidence 
accumulated upon this most serious subject, I would 
not be understood to imply that there exists a doubt in 
the mind of any well-informed member of the medical 



THE CONTAGIOUSNESS OF PUERPERAL FEVER. 129 

profession as to the fact that puerperal fever is some- 
times communicated from one person to another, both 
directly and indirectly. In the present state of our 
knowledge upon this point I should consider such 
doubts merely as a proof that the sceptic had either 
not examined the evidence, or, having examined it, re- 
fused to accept its plain and unavoidable consequences. 
I should be sorry to think, with Dr. Rigby, that it was 
a case of " oblique vision ; " I should be unwilling 
to force home the argumentum ad hominem of Dr. 
Blundell, but I would not consent to make a ques- 
tion of a momentous fact which is no longer to be 
considered as a subject for trivial discussions, but to 
be acted upon with silent promptitude. It signifies 
nothing that wise and experienced practitioners have 
sometimes doubted the reality of the danger in ques- 
tion ; no man has the right to doubt it any longer. 
No negative facts, no opposing opinions, be they what 
they may, or whose they may, can form any answer to 
the series of cases now within the reach of all who 
choose to explore the records of medical science. 

If there are some who conceive that any important 
end would be answered by recording such opinions, or 
by collecting the history of all the cases they could find 
in which no evidence of the influence of contagion ex- 
isted, I believe they are in error. Suppose a few 
writers of authority can be found to profess a disbelief 
in contagion, — and they are very few compared with 
those who think differently, — is it quite clear that 
they formed their opinions on a view of all the facts, 
or is it not apparent that they relied mostly on their 
own solitary experience ? Still further, of those whose 
names are quoted, is it not true that scarcely a single 
one could by any possibility have known the half or 



loU MEDICAL ESSAYS. 

the tenth of the facts bearing on the subject which 
have reached such a frightful amount within the last 
few years ? Again, as to the utility of negative facts, 
as we may briefly call them, — instances, namely, in 
which exposure has not been followed by disease, — al- 
though, like other truths, they may be worth knowing, 
I do not see that they are like to shed any important 
light upon the subject before us. Every such instance 
requires a good deal of circumstantial explanation be- 
fore it can be accepted. It is not enough that a prac- 
titioner should have had a single case of puerperal 
fever not followed by others. It must be known 
whether he attended others while this case was in prog- 
ress, whether he went directly from one chamber to 
others, whether he took any, and what precautions. It 
is important to know that several women were exposed 
to infection derived from the patient, so that allowance 
may be made for want of predisposition. Now if of 
negative facts so sifted there could be accumulated a 
hundred for every one plain instance of communication 
here recorded, I trust it need not be said that we are 
bound to guard and watch over the hundredth tenant 
of our fold, though the ninety and nine may be sure 
of escaping the wolf at its entrance. If any one is dis- 
posed, then, to take a hundred instances of lives en- 
dangered or sacrificed out of those I have mentioned, 
and make it reasonably clear that within a similar time 
and compass ten thov*<nt<l escaped the same exposure, 
I shall thank him for his industry, but I must be per- 
mitted to hold to my own practical conclusions, and 
beg him to adopt or at least to examine them also. 
Children that walk in calico before open fires are not 
always burned to death ; the instances to the contrary 
may be worth recording ; but by no means if they are 



THE CONTAGIOUSNESS OF PUERPERAL FEVER. 131 

to be used as arguments against woollen frocks and 
high fenders. 

I am not sure that this paper will escape another re- 
mark which it might be wished were founded in jus- 
tice. It may be said that the facts are too generally- 
known and acknowledged to require any formal argu- 
ment or exposition, that there is nothing new in the 
positions advanced, and no need of laying additional 
statements before the Profession. But on turning to 
two works, one almost universally, and the other exten- 
sively appealed to as authority in this country, I see 
ample reason to overlook this objection. In the last 
edition of Dewees's Treatise on the " Diseases of Fe- 
males," it is expressly said, " In this country, under no 
circumstance that puerperal fever has appeared hith- 
erto, does it afford the slightest ground for the belief 
that it is contagious." In the " Philadelphia Practice 
of Midwifery " not one word can be found in the chap- 
ter devoted to this disease which would lead the 
reader to suspect that the idea of contagion had ever 
been entertained. It seems proper, therefore, to re- 
mind those who are in the habit of referring to these 
works for guidance, that there may possibly be some 
sources of danger they have slighted or omitted, quite 
as important as a trifling irregularity of diet, or a con- 
fined state of the bowels, and that whatever confidence 
a physician may have in his own mode of treatment, 
his services are of questionable value whenever he car- 
ries the bane as well as the antidote about his person. 

The practical point to be illustrated is the following : 
The disease known as Puerperal Fever is so far 
contagious as to be frequently carried from patient to 
patient by physicians and nurses. 



132 MEDICAL ESSAYS. 

Let me begin by thawing out certain incidental 
questions, which, without being absolutely essential, 
would render the subject more complicated, and by 
making such concessions and assumptions as may be 
fairly supposed to be without the pale of discussion. 

1. It is granted that all the forms of what is called 
puerperal fever may not be, and probably are not, 
equally contagious or infectious. I do not enter into 
the distinctions which have been drawn by authors, 
because the facts do not appear to me sufficient to es- 
tablish any absolute line of demarcation between such 
forms as may be propagated by contagion and those 
which are never so propagated. This general result I 
shall only support by the authority of Dr. Ramsbot- 
ham, who gives, as the result of his experience, that 
the same symptoms belong to what he calls the infec- 
tious and the sporadic forms of the disease, and the 
opinion of Armstrong in his original Essay. If others 
can show any such distinction, I leave it to them to do 
it. But there are cases enough that show the preva- 
lence of the disease among the patients of a single 
practitioner when it was in no degree epidemic, in the 
proper sense of the term. I may refer to those of Mr. 
Roberton and of Dr. Peirson, hereafter to be cited, as 
examples. 

2. I shall not enter into any dispute about the par- 
ticular mode of infection, whether it be by the atmos- 
phere the physician carries about him into the sick- 
chai nber, or by the direct application of the virus to 
the absorbing surfaces with which his hand comes in 
contact. Many facts and opinions are in favor of 
each of these modes of transmission. But it is obvious 
that in the majority of cases it must be impossible to 
decide by which of these channels the disease is con- 



THE CONTAGIOUSNESS OF PUERPERAL FEVER. 133 

veyed, from the nature of the intercourse between the 
physician and the patient. 

3. It is not pretended that the contagion of puer- 
peral fever must always be followed by the disease. 
It is true of all contagious diseases, that they fre- 
quently spare those who appear to be fully submitted 
to their influence. Even the vaccine virus, fresh from 
the subject, fails every day to produce its legitimate 
effect, though every precaution is taken to insure its 
action. This is still more remarkably the case with 
scarlet fever and some other diseases. 

4. It is granted that the disease may be produced 
and variously modified by many causes besides con- 
tagion, and more especially by epidemic and endemic 
influences. But this is not peculiar to the disease in 
question. There is no doubt that small-pox is propa- 
gated to a great extent by contagion, yet it goes 
through the same periods of periodical increase and 
diminution which have been remarked in puerperal 
fever. If the question is asked how we are to recon- 
cile the great variations in the mortality of puerperal 
fever in different seasons and places with the supposi- 
tion of contagion, I will answer it by another question 
from Mr. Farr's letter to the Eegistrar-General. He 
makes the statement that "jive die weekly of small-pox 
in the metropolis when the disease is not epidemic," 
— and adds, " The problem for solution is, — Why do 
the five deaths become 10, 15, 20, 31, 58, 88, weekly, 
and then progressively fall through the same measured 
steps ? " 

5. I take it for granted, that if it can be shown that 
great numbers of lives have been and are sacrificed to 
ignorance or blindness on this point, no other error of 
which physicians or nurses may be occasionally sus- 



134 MEDICAL ESSAYS. 

pected will be alleged in palliation of this ; but that 
whenever and wherever they can be shown to carry 
disease and death instead of health and safety, the 
common instincts of humanity will silence every at- 
tempt to explain away their responsibility. 

The treatise of Dr. Gordon of Aberdeen was pub- 
lished in the year 1795, being among the earlier spec- 
ial works upon the disease. A part of his testimony 
has been occasionally copied into other works, but his 
expressions are so clear, his experience is given with 
such manly distinctness and disinterested honesty, that 
it may be quoted as a model which might have been 
often followed with advantage. 

" This disease seized such women only as were vis- 
ited, or delivered by a practitioner, or taken care of by 
a nurse, who had previously attended patients affected 
with the disease." 

" I had evident proofs of its infectious nature, and 
that the infection was as readily communicated as 
that of the small-pox or measles, and operated more 
speedily than any other infection with which I am 
acquainted." 

" 1 had evident proofs that every person who had 
been with a patient in the puerperal fever became 
charged with an atmosphere of infection, which was 
communicated to every pregnant woman who hap- 
pened to come within its sphere. This is not an asser- 
tion, but a fact, admitting of demonstration, as may 
be seen by a perusal of the foregoing table," — refer- 
ring to a table of seventy-seven cases, in many of 
which the channel of propagation was evident. 

He adds, " It is a disagreeable declaration for me to 
mention, that 1 myself was the means of carrying the 



THE CONTAGIOUSNESS OF PUERPERAL FEVER. 135 

infection to a great number of women." He then 
enumerates a number of instances in which the disease 
was conveyed by midwives and others to the neighbor- 
ing villages, and declares that " these facts fully prove 
that the cause of the puerperal fever, of wlrich I treat, 
was a specific contagion, or infection, altogether un- 
connected with a noxious constitution of the atmos- 
phere." 

But Ins most terrible evidence is given in these 
words : u I arrived at that certainty in the mat- 
ter, THAT I COULD VENTURE TO FORETELL WHAT 
WOMEN WOULD BE AFFECTED WTTH THE DISEASE, 
UPON HEARING BY WHAT MIDWIFE THEY WERE TO 
BE DELIVERED, OR BY WHAT NURSE THEY WERE TO 
BE ATTENDED, DURING THEIR LYING-IN : AND ALMOST 
IN EVERY INSTANCE, MY PREDICTION WAS VERIFIED." 

Even previously to Gordon, Mr. White of Manches- 
ter had said, " I am acquainted with two gentlemen in 
another town, where the whole business of midwifery 
is divided betwixt them, and it is very remarkable that 
one of them loses several patients every year of the 
puerperal fever, and the other never so much as meets 
with the disorder," — a difference which he seems to 
attribute to their various modes of treatment." 

Dr. Armstrong has given a number of instances in 
his Essay on Puerperal Fever, of the prevalence of 
the disease among the patients of a single practitioner. 
At Sunderland, " in all, forty-three cases occurred 
from the 1st of January to the 1st of October, when 
the disease ceased ; and of this number forty were wit- 
nessed by Mr. Gregson and his assistant, Mr. Gregory, 
the remainder having been separately seen by three 
accoucheurs." There is appended to the London edi- 
° On the Management of Lying-in Women, p. 120. 



136 MEDICAL ESSAYS. 

tion of this Essay, a letter from Mr. Gregson, in which 
that gentleman says, in reference to the great number 
of cases occurring in his practice, " The cause of this 
I cannot pretend fully to explain, but I should be 
wanting in common liberality if I were to make any 
hesitation in asserting, that the disease which appeared 
in my practice was highly contagious, and communica- 
ble from one puerperal woman to another." "It is 
customary among the lower and middle ranks of peo- 
ple to make frequent personal visits to puerperal 
women resident in the same neighborhood, and I have 
ample evidence for affirming that the infection of the 
disease was often carried about in that manner ; and, 
however painful to my feelings, I must in candor de- 
clare, that it is very probable the contagion was con- 
veyed, in some instances, by myself, though I took 
every possible care to prevent such a thing from hap- 
pening, the moment that I ascertained that the distem- 
per was infectious." Dr. Armstrong goes on to men- 
tion six other instances within his knowledge, in which 
the disease had at different times and places been lim- 
ited, in the same singular manner, to the practice of 
individuals, while it existed scarcely if at all among 
the patients of others around them. Two of the gen- 
tlemen became so convinced of their conveying the 
contagion, that they withdrew for a time from practice. 

I find a brief notice, in an American Journal, of an- 
other series of cases, first mentioned by Mr. Davies, in 
the " Medical Repository." This gentleman stated his 
conviction that the disease is contagious. 

" In the autumn of 1822 he met with twelve cases, 
while his medical friends in the neighborhood did not 
meet with any, i or at least very few.' He could at- 
tribute this circumstance to no other cause than his 



THE CONTAGIOUSNESS OF PUERPERAL FEVER. 137 

having been present at the examination, after death, 
of two cases, some time previous, and of his having 
imparted the disease to his patients, notwithstanding 
every precaution." ° 

Dr. Gooch says, " It is not uncommon for the greater 
number of cases to occur in the practice of one man, 
whilst the other practitioners of the neighborhood, who 
are not more skilful or more busy, meet with few or 
none. A practitioner opened the body of a woman 
who had died of puerperal fever, and continued to 
wear the same clothes. A lady whom he delivered a 
few days afterwards was attacked with and died of a 
similar disease ; two more of his lying-in patients, in 
rapid succession, met with the same fate ; struck by 
the thought, that he might have carried contagion in 
his clothes, he instantly changed them, and met with 
no more cases of the kind. 6 A woman in the country, 
who was employed as washerwoman and nurse, washed 
the linen of one who had died of puerperal fever ; the 
next lying-in patient she nursed died of the same dis- 
ease ; a third nursed by her met with the same fate, 
till the neighborhood, getting afraid of her, ceased to 
employ her." c 

In the winter of the year 1824, " Several instances 
occurred of its prevalence among the patients of par- 
ticular practitioners, whilst others w r ho were equally 
busy met with few or none. One instance of this kind 
was very remarkable. A general practitioner, in large 
midwifery practice, lost so many patients from puer- 

a Philad. Med. Journal for 1825, p. 408. 

6 A similar anecdote is related by Sir Benjamin Brodie, of 
the late Dr. John Clarke. Lancet, May 2, 1840. 

c An Account of some of the most important Diseases peculiar to 
Women } p. 4. 



138 MEDICAL ESSAYS. 

peral fever, that he determined to deliver no more for 
some time, but that his partner should attend in his 
place. This plan was pursued for one month, during 
which not a case of the disease occurred in their prac- 
tice. The elder practitioner, being then sufficiently 
recovered, returned to his practice, but the first pa- 
tient he attended was attacked by the disease and 
died. A physician, who met him in consultation soon 
afterwards, about a case of a different kind, and who 
knew nothing of his misfortune, asked him whether 
puerperal fever was at all prevalent in his neighbor- 
hood, on which he burst into tears, and related the 
above circumstances. 

" Among the cases which I saw tins season in con- 
sultation, four occurred in one month in the practice 
of one medical man, and all of them terminated fa- 
tally." a 

Dr. Ramsbotham asserted, in a Lecture at the Lon- 
don Hospital, that he had known the disease spread 
through a particular district, or be confined to the 
practice of a particular person, almost every patient 
being attacked with it, while others had not a single 
case. It seemed capable, he thought, of conveyance, 
not only by common modes, but through the dress of 
the attendants upon the patient. 6 

In a letter to be found in the "London Medical 
Gazette " for January, 1840, Mr. Iioberton of Man- 
chester makes the statement which I here give in a 
somewhat condensed form. 

A midwife delivered a woman on the 4th of Decem- 
ber, 1830, who died soon after with the symptoms of 
puerperal fever. In one month from this date the 

" Gooch, Op. elf. p. 71. 

b Lond. Med. Gaz. May 2, 1835. 



THE CONTAGIOUSNESS OF PUERPERAL FEVER. 139 

same midwife delivered thirty women, residing in 
different parts of an extensive suburb, of which num- 
ber sixteen caught the disease and all died. These 
were the only cases which had occurred for a consid- 
erable time in Manchester. The other midwives con- 
nected with the same charitable institution as the 
woman already mentioned are twenty-five in number, 
and deliver, on an average, ninety women a week, or 
about three hundred and eighty a month. None of 
these women had a ease of puerperal fever. " Yet all 
this time this woman was crossing the other midwives 
in every direction, scores of the patients of the charity 
being delivered by them in the very same quarters 
where her cases of fever were happening." 

Mr. Roberton remarks, that little more than half 
the women she delivered during this month took the 
fever ; that on some days all escaped, on others only 
one or more out of three or four ; a circumstance sim- 
ilar to what is seen in other infectious maladies. 

Dr. Blundell says, "Those who have never made 
the experiment can have but a faint conception how 
difficult it is to obtain the exact truth respecting any 
occurrence in which feelings and interests are con- 
cerned. Omitting particulars, then, I content myself 
with remarking, generally, that from more than one 
district I have received accounts of the prevalence of 
puerperal fever in the practice of some individuals, 
while its occurrence in that of others, in the same 
neighborhood, was not observed. Some, as I have 
been told, have lost ten, twelve, or a greater number 
of patients, in scarcely broken succession ; like their 
evil genius, the puerperal fever has seemed to stalk 
behind them wherever they went. Some have deemed 
it prudent to retire for a time from practice. In fine, 



140 MEDICAL ESSAYS. 

that this fever may occur spontaneously, I admit ; 
that its infectious nature may be plausibly disputed, 
I do not deny ; but I add, considerately, that in my 
own family I had rather that those I esteemed the 
most should be delivered, unaided, in a stable, by the 
manger-side, than that they should receive the best 
help, in the fairest apartment, but exposed to the va- 
pors of this pitiless disease. Gossiping friends, wet- 
nurses, monthly nurses, the practitioner himself, these 
are the channels by which, as I suspect, the infection 
is principally conveyed." a 

At a meeting of the Royal Medical and Chirurgical 
Society, Dr. King mentioned that some years since a 
practitioner at Woolwich lost sixteen patients from 
puerperal fever in the same year. He was compelled 
to give up practice for one or two years, his business 
being divided among the neighboring practitioners. 
No case of puerperal fever occurred afterwards, nei- 
ther had any of the neighboring surgeons any cases of 
this disease. 

At the same meeting Mr. Hutchinson mentioned 
the occurrence of three consecutive cases of puerperal 
fever, followed subsequently by two others, all in the 
practice of one accoucheur. 6 

Dr. Lee makes the following statement : " In the 
last two weeks of September, 1827, five fatal cases of 
uterine inflammation came under our observation. 
All the individuals so attacked had been attended in 
labor by the same midwife, and no example of a febrile 
or inflammatory disease of a serious nature occurred 
during that period among the other patients of the 
Westminster General Dispensary, who had been at- 

a Led. on Midwifery, p. 395. 
6 Lancet, May 2, 1840. 



THE CONTAGIOUSNESS OF PUEKPERAL FEVER. 141 

tended by the other midwives belonging to that insti- 
tution. " a 

The recurrence of long series of cases like those I 
have cited, reported by those most interested to dis- 
believe in contagion, scattered along through an inter- 
val of half a century, might have been thought suffi- 
cient to satisfy the minds of all inquirers that here 
was something more than a singular coincidence. But 
if, on a more extended observation, it should be found 
that the same ominous groups of cases clustering 
about individual practitioners were observed in a re- 
mote country, at different times, and in widely sepa- 
rated regions, it would seem incredible that any should 
be found too prejudiced or indolent to accept the 
solemn truth knelled into their ears by the funeral 
bells from both sides of the ocean, — the plain con- 
clusion that the physician and the disease entered, 
hand in hand, into the chamber of the unsuspecting 
patient. 

That such series of cases have been observed in this 
country, and in this neighborhood, I proceed to show. 

In Dr. Francis's " Notes to Denman's Midwifery," 
a passage is cited from Dr. Hosack, in which he refers 
to certain puerperal cases which proved fatal to several 
lying-in women, and in some of which the disease was 
supposed to be conveyed by the accoucheurs them- 
selves. 6 

A writer in the " New York Medical and Physical 
Journal " for October, 1829, in speaking of the occur- 
rence of puerperal fever, confined to one man's prac- 
tice, remarks, " We have known cases of this kind 
occur, though rarely, in New York." 

* Loud. Cyc. of Prac.t. Med. art. " Fever, Puerperal." 
6 Denman's Midwifery, p. 673, 3d Am. ed. 



142 MEDICAL ESSAYS. 

I mention these little hints about the occurrence of 
such cases, partly because they are the first I have 
met with in American medical literature, but more 
especially because they serve to remind us that be- 
hind the fearful array of published facts there lies a 
dark list of similar events, unwritten in the records 
of science, but long remembered by many a desolated 
fireside. 

Certainly nothing can be more open and explicit 
than the account given by Dr. Peirson of Salem, of 
the cases seen by him. In the first nineteen days of 
January, 1829, he had five consecutive cases of puer- 
peral fever, every patient he attended being attacked, 
and the three first cases proving fatal. In March of 
the same year he had two moderate cases, in June, 
another case, and in July, another, which proved fatal. 
"Up to this period," he remarks, w I am not informed 
that a single case had occurred in the practice of any 
other physician. Since that period I have had no 
fatal case in my practice, although I have had sev- 
eral dangerous cases. I hare attended in all twenty 
cases of this disease, of which four have been fatal. 
I am not aware that there has been any other case in 
the town of distinct puerperal peritonitis, although I 
am willing to admit my information may be very de- 
fective on this point. I have been told of some ' mixed 
cases,' and ' morbid affections after delivery.' " a 

In the "Quarterly Summary of the Transactions of 
the College of Physicians of Philadelphia " b may be 
found some most extraordinary developments respect- 
ing a series of cases occurring in the practice of a 
member of that body. 

° Remarks on Puerperal Fecer, pp. 12 and 13. 
6 For May, June, and July, 1842. 



THE CONTAGIOUSNESS OF PUERPERAL FEVER. 143 

Dr. Condie called the attention of the Society to the 
prevalence, at the present time, of puerperal fever of a 
peculiarly insidious and malignant character. " In the 
practice of one gentleman extensively engaged as an 
obstetrician, nearly every female he has attended in 
confinement, during several weeks past, within the 
above limits " (the southern sections and neighboring 
districts), "had been attacked by the fever." 

" An important query presents itself, the Doctor ob- 
served, in reference to the particular form of fever now 
prevalent. Is it, namely, capable of being propagated 
by contagion, and is a physician who has been in at- 
tendance upon a case of the disease warranted in 
continuing, without interruption, his practice as an 
obstetrician ? Dr. C, although not a believer in the 
contagious character of many of those affections gener- 
ally supposed to be propagated in this manner, has 
nevertheless become convinced by the facts that have 
fallen under his notice, that the puerperal fever now 
prevailing is capable of being communicated by con- 
tagion. How otherwise can be explained the very 
curious circumstance of the disease in one district being 
exclusively confined to the practice of a single phy- 
sician, a Fellow of this College, extensively engaged in 
obstetrical practice, — while no instance of the disease 
has occurred in the patients under the care of any 
other accoucheur practising within the same district ; 
scarcely a female that has been delivered for weeks 
past has escaped an attack? " 

Dr. Rutter, the practitioner referred to, " observed 
that, after the occurrence of a number of cases of the 
disease in his practice, he had left the city and re- 
mained absent for a week, but on returning, no art- 
icle of clothing he then wore having been used by him 



144 MEDICAL ESSAYS. 

before, one of the very first cases of parturition he at- 
tended was followed by an attack of the fever, and ter- 
minated fatally ; he cannot, readily, therefore, believe 
in the transmission of the disease from female to fe- 
male, in the person or clothes of the physician." 

The meeting at which these remarks were made was 
held on the 3d of May, 1842. In a letter dated De- 
cember 20, 1842, addressed to Dr. Meigs, and to be 
found in the " Medical Examiner," a he speaks of " those 
horrible cases of puerperal fever, some of which you 
did me the favor to see with me during the past sum- 
mer," and talks of his experience in the disease, " now 
numbering nearly seventy cases, all of which have oc- 
curred within less than a twelvemonth past." 

And Dr. Meigs asserts, on the same page, " Indeed, 
I believe that his practice in that department of the 
profession was greater than that of any other gentle- 
man, which was probably the cause of his seeing a 
greater number of the cases." This from a professor 
of midwifery, who some time ago assured a gentleman 
whom he met in consultation, that the night on which 
they met was the eighteenth in succession that he him- 
self had been summoned from his repose,* seems 
hardly satisfactory. 

I must call the attention of the inquirer most par- 
ticularly to the Quarterly Report above referred to, 
and the letters of Dr. Meigs and Dr. Eutter, to be 
found in the " Medical Examiner." Whatever impres- 
sion they may produce upon his mind, I trust they will 
at least convince him that there is some reason for 
looking into this apparently uninviting subject. 

At a meeting of the College of Physicians just men- 

° For January 21, 1843. 

b Medical Examiner for December 10, 1842. 



THE CONTAGIOUSNESS OF PUERPERAL FEVER. 145 

tioned, Dr. Warrington stated, that a few days after 
assisting at an autopsy of puerperal peritonitis, in 
which he laded out the contents of the abdominal cav- 
ity with his hands, he was called upon to deliver three 
women in rapid succession. All of these women were 
attacked with different forms of what is commonly 
called puerperal fever. Soon after these he saw two 
other patients, both on the same day, with the same 
disease. Of these five patients two died. 

At the same meeting, Dr. West mentioned a fact 
related to him by Dr. Samuel Jackson of Northum- 
berland. Seven females, delivered by Dr. Jackson in 
rapid succession, while practising in Northumberland 
County, were all attacked with puerperal fever, and 
five of them died. " Women," he said, " who had ex- 
pected me to attend upon them, now becoming alarmed, 
removed out of my reach, and others sent for a physi- 
cian residing several miles distant. These women, as 
well as those attended by midwives, all did well ; nor 
did we hear of any deaths in child-bed within a radius 
of fifty miles, excepting two, and these I afterwards 
ascertained to have been caused by other diseases." 
He underwent, as he thought, a thorough purification, 
and still his next patient was attacked with the disease 
and died. He was led to suspect that the contagion 
might have been carried in the gloves which he had 
worn in attendance upon the previous cases. Two 
months or more after this he had two other cases. He 
could find nothing to account for these, unless it were 
the instruments for giving enemata, which had been 
used in two of the former cases, and were employed by 
these patients. When the first case occurred, he was 
attending and dressing a limb extensively mortified 
from erysipelas, and went immediately to the accouche- 

10 



146 MEDICAL ESSAYS. 

ment with his clothes and gloves most thoroughly 
imbued with its effluvia. And here I may mention, 
that this very Dr. Samuel Jackson of Northumber- 
land is one of Dr. Dewees's authorities against con- 
tagion. 

The three following statements are now for the first 
time given to the public. All of the cases referred to 
occurred within this State, and two of the three series 
in Boston and its immediate vicinity. 

I. The first is a series of cases which took place 
during the last spring in a town at some distance from 
this neighborhood. A physician of that town, Dr. C, 
had the following consecutive cases. 

No. 1, delivered March 20, died March 24. 



t< 


2, 


u 


April 


9, " 


April 14. 


u 


3, 


M 


tc 


10, " 


« 14. 


u 


4, 


u 


K 


11, « 


" 18. 


M 


5, 


u 


K 


27, 


May 3. 


u 


6, 


u 


(( 


28, had 


some symptoms, 
[recovered. 


tc 


7, 


U 


May 


8, had 


some symptoms, 
[also recovered. 



These were the only cases attended by this physi- 
cian during the period referred to. " They were all 
attended by him until their termination, with the ex- 
ception of the patient No. 6, who fell into the hands 
of another physician on the 2d of May. (Dr. C. left 
town for a few days at this time.) Dr. C. attended 
cases immediately before and after the above-named 
periods, none of which, however, presented any pe- 
culiar symptoms of the disease. 

About the 1st of July he attended another patient 



THE CONTAGIOUSNESS OF PUERPERAL FEVER. 147 

in a neighboring village, who died two or three days 
after delivery. 

The first patient, it is stated, was delivered on the 
20th of March. "On the 19th, Dr. C. made the 
autopsy of a man who died suddenly, sick only forty- 
eight hours ; had oedema of the thigh, and gangrene 
extending from a little above the ankle into the cavity 
of the abdomen." Dr. C. wounded himself, very 
slightly, in the right hand during the autopsy. The 
hand was quite painful the night following, during his 
attendance on the patient No. 1. He did not see this 
patient after the 20th, being confined to the house, 
and very sick from the wound just mentioned, from 
this time until the 3d of April. 

Several cases of erysipelas occurred in the house 
where the autopsy mentioned above took place, soon 
after the examination. There were also many cases 
of erysipelas in town at the time of the fatal puerperal 
cases which have been mentioned. 

The nurse who laid out the body of the patient No. 

3 was taken on the evening of the same day with sore 
throat and erysipelas, and died in ten days from the 
first attack. 

The nurse who laid out the body of the patient No. 

4 was taken on the day following with symptoms like 
those of this patient, and died in a week, without any 
external marks of erysipelas. 

" No other cases of similar character with those of 
Dr. C. occurred in the practice of any of the physicians 
in the town or vicinity at the time. Deaths following 
confinement have occurred in the practice of other 
physicians during the past year, but they were not 
cases of puerperal fever. No post-mortem examina- 
tions were held in any of these puerperal cases." 



148 MEDICAL ESSAYS. 

Some additional statements in this letter are deserv- 
ing of insertion. 

" A physician attended a woman in the immediate 
neighborhood of the cases numbered 2, 3, and 4. 
This patient was confined the morning of March 1st, 
and died on the night of March 7th. It is doubtful 
whether this should be considered a case of puerperal 
fever. She had suffered from canker, indigestion, and 
diarrhoea for a year previous to her delivery. Her 
complaints were much aggravated for two or three 
months previous to delivery ; she had become greatly 
emaciated, and weakened to such an extent that it 
had not been expected that she would long survive her 
confinement, if indeed she reached that period. Her 
labor was easy enough ; she flowed a good deal, seemed 
exceedingly prostrated, had ringing in the ears, and 
other symptoms of exhaustion ; the pulse was quick and 
small. On the second and third day there was some 
tenderness and tumefaction of the abdomen, which in- 
creased somewhat on the fourth and fifth. He had 
cases in midwifery before and after this, which pre- 
sented nothing peculiar." 

It is also mentioned in the same letter, that another 
physician had a case during the last summer and an- 
other last fall, both of which recovered. 

Another gentleman reports a case last December, a 
second case five weeks, and another three weeks since. 
AH these recovered. A case also occurred very re- 
cently in the practice of a physician in the village 
where the eighth patient of Dr. C. resides, which 
proved fatal. " This patient had some patches of ery- 
sipelas on the legs and arms. The same physician has 
delivered three cases since, which have all done well. 
There have been no other cases in this town or its vi- 



THE CONTAGIOUSNESS OF PUERPERAL FEVER. 149 

cinity recently. There have been some few cases of 
erysipelas." It deserves notice that the partner of Dr. 
C, who attended the autopsy of the man above men- 
tioned and took an active part in it ; who also suffered 
very slightly from a prick under the thumb-nail re- 
ceived during the examination, had twelve cases of 
midwifery between March 26th and April 12th, all of 
which did well, and presented no peculiar symptoms. 
It should also be stated, that during these seventeen 
days he was in attendance on all the cases of erysipe- 
las in the house where the autopsy had been per- 
formed. 

I owe these facts to the prompt kindness of a gen- 
tleman whose intelligence and character are sufficient 
guaranty for their accuracy. 

The two following letters were addressed to my 
friend Dr. Storer, by the gentleman in whose practice 
the cases of puerperal fever occurred. His name ren- 
ders it unnecessary to refer more particularly to these 
gentlemen, who on their part have manifested the 
most perfect freedom and courtesy in affording these 
accounts of their painful experience. 

"January 28, 1843. 

II. . . . " The time to which you allude was in 
1830. The first case was in February, during a very 
cold time. She was confined the 4th, and died the 
12th. Between the 10th and 28th of this month, I at- 
tended six women in labor, all of whom did well ex- 
cept the last, as also two who were confined March 1st 
and 5th. Mrs. E., confined February 28th, sickened, 
and died March 8th. The next day, 9th, I inspected 
the body, and the night after attended a lady, Mrs. 
15., who sickened, and died 16th. The 10th, I at- 



150 MEDICAL ESSAYS. 

tended another, Mrs. G., who sickened, but recovered. 
March 16th, I went from Mrs. G.'s room to attend a 
Mrs. H., who sickened, and died 21st. The 17th, I 
inspected Mrs. B. On the 19th, I went directly from 
Mrs. H.'s room to attend another lady, Mrs. G., who 
also sickened, and died 22d. While Mrs. B. was sick, 
on 15th, I went directly from her room a few rods, and 
attended another woman, who was not sick. Up to 
20th of this month I wore the same clothes. I now 
refused to attend any labor, and did not till April 
21st, when, having thoroughly cleansed myself, 1 re- 
sumed my practice, and had no more puerperal fever. 

"The cases were not confined to a narrow space. 
The two nearest were half a mile from each other, and 
half that distance from my residence. The others 
were from two to three miles apart, and nearly that 
distance from my residence. There were no other 
cases in their immediate vicinity which came to my 
knowledge. The general health of all the women was 
pretty good, and all the labors as good as common, 
except the first. This woman, in consequence of my 
not arriving in season, and the child being half -born 
at some time before I arrived, was very much exposed 
to the cold at the time of confinement, and afterwards, 
being confined in a very open, cold room. Of the six 
cases you perceive only one recovered. 

" In the winter of 1817 two of my patients had pu- 
erperal fever, one very badly, the other not so badly. 
Both recovered. One other had swelled leg, or phleg- 
masia dolens, and one or two others did not recover as 
well as usual. 

" In the summer of 1835 another disastrous period 
occurred in my practice. July 1st, I attended a lady 
in labor, who was afterwards quite ill and feverish; 



THE CONTAGIOUSNESS OF PUERPERAL FEVER. 151 

but at the time I did not consider her case a decided 
puerperal fever. On the 8th, I attended one who did 
well. On the 12th, one who was seriously sick. This 
was also an equivocal case, apparently arising from 
constipation and irritation of the rectum. These 
women were ten miles apart and five from my resi- 
dence. On 15th and 20th, two who did well. On 
25th, I attended another. This was a severe labor, 
and followed by unequivocal puerperal fever, or peri- 
tonitis. She recovered. August 2d and 3d, in about 
twenty-four hours I attended four persons. Two of 
them did very well ; one was attacked with some of 
the common symptoms, which however subsided in a 
day or two, and the other had decided puerperal fever, 
but recovered. This woman resided five miles from 
me. Up to this time I wore the same coat. All my 
other clothes had frequently been changed. On 6th, I 
attended two women, one of whom was not sick at all ; 
but the other, Mrs. L., was afterwards taken ill. On 
10th, I attended a lady, who did very well. I had 
previously changed all my clothes, and had no gar- 
ment on winch had been in a puerperal room. On 12th, 
I was called to Mrs. S., in labor. While she was ill, 
I left her to visit Mrs. L., one of the ladies who was 
confined on 6th. Mrs. L. had been more unwell than 
usual, but I had not considered her case anything 
more than common till this visit. I had on a surtout 
at this visit, which, on my return to Mrs. S., I left in 
another room. Mrs. S. was delivered on 13th with 
forceps. These women both died of decided puerperal 
fever. 

" While I attended these women in their fevers, I 
changed my clothes, and washed my hands in a solu- 
tion of chloride of lime after each visit. I attended 



152 MEDICAL ESSAYS. 

seven women in labor during this period, all of whom 
recovered without sickness. 

" In my practice I have had several single cases of 
puerperal fever, some of whom have died and some 
have recovered. Until the year 1830 I had no sus- 
picion that the disease could be communicated from 
one patient to another by a nurse or midwife ; but I now 
think the foregoing facts strongly favor that idea. I 
was so much convinced of this fact, that I adopted the 
plan before related. 

" I believe my own health was as good as usual at 
each of the above periods. I have no recollection to 
the contrary. 

" I believe I have answered all your questions. I 
have been more particular on some points perhaps than 
necessary; but I thought you could form your own 
opinion better than to take mine. In 1830 I wrote to 
Dr. Channing a more particular statement of my cases. 
If I have not answered your questions sufficiently, 
perhaps Dr. C. may have my letter to him, and you 
can find your answer there." a 

"Boston, February 3, 1843. 
III. " My dear Sir, — I received a note from you 
last evening, requesting me to answer certain questions 
therein proposed, touching the cases of puerperal fever 
which came under my observation the past summer. 
It gives me pleasure to comply with your request, so 
far as it is in my power so to do, but, owing to the 
hurry in preparing for a journey, the notes of the 
cases I had then taken were lost or mislaid. The prin- 

° In a letter to myself, this gentleman also stated, " I do not 
recollect that there was any erysipelas or any other disease par- 
ticularly prevalent at the time." 



THE CONTAGIOUSNESS OF PUERPERAL FEVER. 153 

cipal facts, however, are too vivid upon my recollection 
to be soon forgotten. I think, therefore, that I shall 
be able to give you all the information you may require. 

"All the cases that occurred in my practice took 
place between the 7th of May and the 17th of June 
1842. 

" They were not confined to any particular part of 
the city. The first two cases were patients residing at 
the South End, the next was at the extreme North 
End, one living in Sea Street and the other in Rox- 
bury. The following is the order in which they oc- 
curred : — 

" Case 1. Mrs. was confined on the 7th of 

May, at 5 o'clock, p. m., after a natural labor of six 
hours. At 12 o'clock at night, on the 9th (thirty-one 
hours after confinement), she was taken with severe 
chill, previous to which she was as comfortable as 
women usually are under the circumstances. She died 
on the 10th. 

"Case 2. Mrs. was confined on the 10th of 

June (four weeks after Mrs. C), at 11 a. m., after a 
natural, but somewhat severe labor of five hours. At 
7 o'clock, on the morning of the 11th, she had a chill. 
Died on the 12th. 

" Case 3. Mrs. , confined on the 14th of June, 

was comfortable until the 18th, when symptoms of 
puerperal fever were manifest. She died on the 20th. 

"Case 4. Mrs. , confined June 17th, at 5 

o'clock, A. M., was doing well until the morning of the 
19th. She died on the evening of the 21st. 

" Case 5. Mrs. was confined with her fifth 

child on the 17th of June, at 6 o'clock in the evening. 
This patient had been attacked with puerperal fever, 
at three of her previous confinements, but the disease 



154 MEDICAL ESSAYS. 

yielded to depletion and other remedies without diffi- 
culty. This time, I regret to say, I was not so fortu- 
nate. She was not attacked, as were the other patients, 
with a chill, but complained of extreme pain in abdo- 
men, and tenderness on pressure, almost from the mo- 
ment of her confinement. In this as in the other cases, 
the disease resisted all remedies, and she died in great 
distress on the 22d of the same month. Owing to 
the extreme heat of the season, and my own indispo- 
sition, none of the subjects were examined after death. 
Dr. Channing, who was in attendance with me on the 
three last cases, proposed to have a post-mortem ex- 
amination of the subject of case No. 5, but from some 
cause which I do not now recollect it was not obtained. 

" You wish to know whether I wore the same clothes 
when attending the different cases. I cannot positively 
say, but I should think I did not, as the weather 
became warmer after the first two cases ; I therefore 
think it probable that I made a change of at least a 
part of my dress. I have had no other case of puer- 
peral fever in my own practice for three years, save 
those above related, and I do not remember to have 
lost a patient before with this disease. While absent, 
last July, I visited two patients sick with puerperal 
fever, with a friend of mine in the country. Both of 
them recovered. 

" The cases that I have recorded were not confined 
to any particular constitution or temperament, but it 
seized upon the strong and the weak, the old and the 
young, — one being over forty years, and the youngest 
under eighteen years of age. ... If the disease is of 
an erysipelatous nature, as many suppose, contagionists 
may perhaps find some ground for their belief in the 
fact, that, for two weeks previous to my first case of 



THE CONTAGIOUSNESS OF PUERPERAL FEVER. 155 

puerperal fever, I had been attending a severe case of 
erysipelas, and the infection may have been conveyed 
through me to the patient ; but, on the other hand, why 
is not this the case with other physicians, or with the 
same physician at all times, for since my return from 
the country I have had a more inveterate case of ery- 
sipelas than ever before, and no difficulty whatever has 
attended any of my midwifery cases ? " 

I am assured, on unquestionable authority, that 
"About three years since, a gentleman in extensive 
midwifery business, in a neighboring State, lost in the 
course of a few weeks eight patients in child-bed, seven 
of them being undoubted cases of puerperal fever. No 
other physician of the town lost a single patient of this 
disease during the same period." And from what I 
have heard in conversation with some of our most ex- 
perienced practitioners, I am inclined to think many 
cases of the kind might be brought to light by exten- 
sive inquiry. 

This long catalogue of melancholy histories assumes 
a still darker aspect when we remember how kindly 
nature deals with the parturient female, when she is 
not immersed in the virulent atmosphere of an impure 
lying-in hospital, or poisoned in her chamber by the 
unsuspected breath of contagion. From all causes 
together, not more than four deaths in a thousand 
births and miscarriages happened in England and 
Wales during the period embraced by the first Report 
of the Registrar-General." In the second Report the 
mortality was shown to be about five in one thousand.* 
In the Dublin Lying-in Hospital, during the seven 
a 1st Report, p. 105. * 2d Report, p. 73. 



156 MEDICAL ESSAYS. 

years of Dr. Collins's mastership, there was one case 
of puerperal fever to 178 deliveries, or less than six 
to the thousand, and one death from this disease in 
278 cases, or between three and four to the thousand." 
Yet during this period the disease was endemic in the 
hospital, and might have gone on to rival the horrors 
of the pestilence of the Maternite*, had not the poison 
been destroyed by a thorough purification. 

In private practice, leaving out of view the cases 
that are to be ascribed to the self-acting system of prop- 
agation, it would seem that the disease must be far 
from common. Mr. White of Manchester says, " Out 
of the whole number of lying-in patients whom I have 
delivered (and I may safely call it a great one), I 
have never lost one, nor to the best of my recollection 
has one been greatly endangered, by the puerperal, 
miliary, low nervous, putrid malignant, or milk fever." b 
Dr. Joseph Clarke informed Dr. Collins, that in the 
course of forty-five years' most extensive practice he 
lost but four patients from this disease. One of the 
most eminent practitioners of Glasgow, who has been 
engaged in very extensive practice for upwards of a 
quarter of a century, testifies that he never saw more 
than twelve cases of real puerperal f ever. d 

I have myself been told by two gentlemen practising 
in this city, and having for many years a large mid- 
wifery business, that they had neither of them lost a 
patient from this disease, and by one of them that he 
had only seen it in consultation with other physicians. 
In five hundred cases of midwifery, of which Dr. Storer 

° Collins's Treatise on Midwifery, p. 228, etc. 

6 Op.cit. p. 115. 

" Op. tit. p. 228. 

d Lancet, May 4, 1833. 



THE CONTAGIOUSNESS OF PUERPERAL FEVER. 157 

has given an abstract in the first number of this Journal, 
there was only one instance of fatal puerperal peritonitis. 

In the view of these facts, it does appear a singular 
coincidence, that one man or woman should have ten, 
twenty, thirty, or seventy cases of this rare disease fol- 
lowing his or her footsteps with the keenness of a 
beagle, through the streets and lanes of a crowded city, 
while the scores that cross the same paths on the same 
errands know it only by name. It is a series of simi- 
lar coincidences which has led us to consider the dag- 
ger, the musket, and certain innocent-looking white 
powders as having some little claim to be regarded as 
dangerous. It is the practical inattention to similar 
coincidences which has given rise to the unpleasant but 
often necessary documents called indictments, which 
has sharpened a form of the cephalotome sometimes 
employed in the case of adults, and adjusted that modi- 
fication of the fillet which delivers the world of those 
who happen to be too much in the way while such 
striking coincidences are taking place. 

I shall now mention a few instances in which the 
disease appears to have been conveyed by the process 
of direct inoculation. 

Dr. Campbell of Edinburgh states that in October, 
1821, he assisted at the post-mortem examination of a 
patient who died with puerperal fever. He carried the 
pelvic viscera in his pocket to the class-room. The 
same evening he attended a woman in labor without 
previously changing his clothes ; this patient died. 
The next morning he delivered a woman with the for- 
ceps ; she died also, and of many others who were 
seized with the disease within a few weeks, three shared 
the same fate in succession. 

In June, 1823, he assisted some of his pupils at the 



158 MEDICAL ESSAYS. 

autopsy of a case of puerperal fever. He was unable 
to wash his hands with proper care, for want of the 
necessary accommodations. On getting home he found 
that two patients required Ms assistance. He went 
without further ablution, or changing his clothes ; both 
these patients died with puerperal fever. a This same 
Dr. Campbell is one of Dr. Churchill's authorities 
against contagion. 

Mr. Roberton says that in one instance within his 
knowledge a practitioner passed the catheter for a 
patient with puerperal fever late in the evening ; the 
same night he attended a lady who had the symptoms 
of the disease on the second day. In another instance 
a surgeon was called while in the act of inspecting the 
body of a woman who had died of this fever, to attend 
a labor ; within forty-eight hours this patient was seized 
with the fever. * 

On the 16th of March, 1831, a medical practitioner 
examined the body of a woman who had died a few 
days after delivery, from puerperal peritonitis. On 
the evening of the 17th he delivered a patient, who was 
seized with puerperal fever on the 19th, and died on 
the 24th. Between this period and the 6th of April, 
the same practitioner attended two other patients, both 
of whom were attacked with the same disease and 
died. c 

In the autumn of 1829 a physician was present at 
the examination of a case of puerperal fever, dissected 
out the organs, and assisted in sewing up the body. 
He had scarcely reached home when he was summoned 
to attend a young lady in labor. In sixteen hours she 

° Lond.Med. Gazelle, December 10, 1831. 

6 Ibid, for January, 1832. 

• London Cyc. of Pract. Med. art. " Fever, Puerperal' ' 



THE CONTAGIOUSNESS OF PUERPERAL FEVER. 159 

was attacked with the symptoms of puerperal fever, 
and narrowly escaped with her life. a 

In December, 1830, a midwife, who had attended two 
fatal cases of puerperal fever at the British Lying-in 
Hospital, examined a patient who had just been ad- 
mitted, to ascertain if labor had commenced. This 
patient remained two days in the expectation that labor 
would come on, when she returned home and was then 
suddenly taken in labor and delivered before she could 
set out for the hospital. She went on favorably for 
two days, and was then taken with puerperal fever and 
died in thirty-six hours.* 

" A young practitioner, contrary to advice, examined 
the body of a patient who had died from puerperal 
fever; there was no epidemic at the time; the case 
appeared to be purely sporadic. He delivered three 
other women shortly afterwards ; they all died with 
puerperal fever, the symptoms of which broke out very 
soon after labor. The patients of his colleague did 
well, except one, where he assisted to remove some co- 
agula from the uterus ; she was attacked in the same 
manner as those whom he had attended, and died also." 
The writer in the " British and Foreign Medical Re- 
view," from whom I quote this statement, — and who 
is no other than Dr. Rigby, — adds, " We trust that 
this fact alone will forever silence such doubts, and 
stamp the well-merited epithet of ' criminal,' as above 
quoted, upon, such attempts." c 

From the cases given by Mr. Ingleby, I select the 
following. Two gentlemen, after having been engaged 
in conducting the post-mortem examination of a case of 

° London Cyc. of Pract. Med. art. " Fever, Puerperal. " 

6 Ibid. 

e Brit, and For. Medical Review for Jan. 1842, p. 112. 



160 MEDICAL ESSAYS. 

puerperal fever, went in the same dress, each respect- 
ively, to a case of midwifery. " The one patient was 
seized with the rigor about thirty hours afterwards. 
The other patient was seized with a rigor the third 
morning after delivery. One recovered, one died" a 
One of these same gentlemen attended another woman 
in the same clothes two days after the autopsy referred 
to. " The rigor did not take place until the evening 
of the fifth day from the first visit. Result fatal." 
These cases belonged to a series of seven, the first of 
which was thought to have originated in a case of ery- 
sipelas. " Several cases of a mild character followed 
the foregoing seven, and their nature being now most 
unequivocal, my friend declined visiting all midwifery 
cases for a time, and there was no recurrence of the 
disease." These cases occurred in 1833. Five of them 
proved fatal. Mr. Ingleby gives another series of seven 
cases which occurred to a practitioner in 1836, the first 
of which was also attributed to his having opened sev- 
eral erysipelatous abscesses a short time previously. 

I need not refer to the case lately read before this 
Society, in which a physician went, soon after perform- 
ing an autopsy of a case of puerperal fever, to a woman 
in labor, who was seized with the same disease and per- 
ished. The forfeit of that error has been already paid. 

At a meeting of the Medical and Chirurgical Society 
before referred to, Dr. Merriman related an instance oc- 
curring in his own practice, which excites a reasonable 
suspicion that two lives were sacrificed to a still less 
dangerous experiment. He was at the examination of 
a case of puerperal fever at two o'clock in the after- 
noon. He tooh care not to touch the body. At nine 
o'clock the same evening he attended a woman in la- 
a Edin. Med. and Surg. Journal, April, 1838. 



THE CONTAGIOUSNESS OF PUERPERAL FEVER. 161 

bor ; she was so nearly delivered that he had scarcely 
anything to do. The next morning she had severe 
rigors, and in forty-eight hours she was a corpse. Her 
infant had erysipelas and died in two days. a 

In connection with the facts which have been stated, 
it seems proper to allude to the dangerous and often 
fatal effects which have followed from wounds received 
in the post-mortem examination of patients who have 
died of puerperal fever. The fact that such wounds 
are attended with peculiar risk has been long noticed. 
I find that Chaussier was in the habit of cautioning 
his students against the danger to which they were ex- 
posed in these dissections. 6 The head pharmacien of 
the HOtel Dieu, in Ms analysis of the fluid effused in 
puerperal peritonitis, says that practitioners are con- 
vinced of its deleterious qualities, and that it is very 
dangerous to apply it to the denuded skin. c Sir Ben- 
jamin Brodie speaks of it as being well known that 
the inoculation of lymph or pus from the peritoneum 
of a puerperal patient is often attended with danger- 
ous and even fatal symptoms. Three cases in confir- 
mation of this statement, two of them fatal, have been 
reported to this Society within a few months. 

Of about fifty cases of injuries of this kind, of various 
degrees of severity, which I have collected from differ- 
ent sources, at least twelve were instances of infection 
from puerperal peritonitis. Some of the others are so 
stated as to render it probable that they may have 
been of - the same nature. Five other cases were of 
peritoneal inflammation : three in males. Three were 

a Lancet, May 2, 1840. 

6 Stein, IS Art <V Accoucher, 179-4; Diet, des Sciences Me'di- 
cales, art. "Puerperal." 
c Journal de Pharmacie, January, 1836. 
11 



162 MEDICAL ESSAYS. 

what was called enteritis, in one instance complicated 
with erysipelas ; but it is well known that this term has 
been often used to signify inflammation of the perito- 
neum covering the intestines. On the other hand, no 
case of typhus or typhoid fever is mentioned as giving 
rise to dangerous consequences, with the exception of 
the single instance of an undertaker mentioned by 
Mr. Travers, who seems to have been poisoned by a 
fluid which exuded from the body. The other acci- 
dents were produced by dissection, or some other mode 
of contact with bodies of patients who had died of va- 
rious affections. They also differed much in severity, 
the cases of puerperal origin being among the most 
formidable and fatal. Now a moment's reflection will 
show that the number of cases of serious consequences 
ensuing from the dissection of the bodies of those who 
had perished of puerperal fever is so vastly dispro- 
portioned to the relatively small number of autopsies 
made in this complaint as compared with typhus or 
pneumonia (from which last disease not one case of 
poisoning happened), and still more from all diseases 
put together, that the conclusion is irresistible that a 
most fearful morbid poison is often generated in the 
course of this disease. Whether or not it is sui gen- 
eric, confined to this disease, or produced in some 
others, as, for instance, erysipelas, I need not stop to 
inquire. 

In connection with this may be taken the following 
statement of Dr. Rigby. " That the discharges from 
a patient under puerperal fever are in the highest de- 
gree contagious we have abundant evidence in the his- 
tory of lying-in hospitals. The puerperal abscesses are 
also contagious, and may be communicated to healthy 
lying-in women by washing with the same sponge ; this 



THE CONTAGIOUSNESS OF PUERPERAL FEVER. 163 

fact has been repeatedly proved in the Vienna Hos- 
pital ; but they are equally communicable to women 
not pregnant ; on more than one occasion the women 
engaged in washing the soiled bed- linen of the General 
Lying-in Hospital have been attacked with abscess in 
the fingers or hands, attended with rapidly spreading 
inflammation of the cellular tissue." a 

Now add to all this the undisputed fact, that within 
the walls of lying-in hospitals there is often generated 
a miasm, palpable as the chlorine used to destroy it, 
tenacious so as in some cases almost to defy extirpa- 
tion, deadly in some institutions as the plague ; which 
iias killed women in a private hospital of London so 
fast that they were buried two in one coffin to conceal 
its horrors ; which enabled Tonnelle to record two 
hundred and twenty-two autopsies at the Maternite of 
P< r jris ; which has led Dr. Lee to express his deliber- 
ate conviction that the loss of life occasioned by these 
institutions completely defeats the objects of their found- 
erf ; and out of this train of cumulative evidence, the 
multiplied groups of cases clustering about individuals, 
the deadly results of autopsies, the inoculation by 
fluids from the living patient, the murderous poison of 
hospitals, — does there not result a conclusion that 
laughs all sophistry to scorn, and renders all argument 
an insult ? 

I have had occasion to mention some instances in 
which there was an apparent relation between puer- 
peral fever and erysipelas. The length to which this 
paper has extended does not allow me to enter into the 
consideration of this most important subject. I will 
only say, that the evidence appears to me altogether 
satisfactory that some most fatal series of puerperal 
a System of Midwifery, p. 292. 



164 MEDICAL ESSAYS. 

fever have been produced by an infection originating" 
in the matter or effluvia of erysipelas. In evidence of 
some connection between the two diseases, I need not 
go back to the older authors, as Pouteau or Gordon, 
but will content myself with giving the following refer- 
ences, with their dates ; from which it will be seen 
that the testimony has been constantly coming before 
the profession for the last few years. 

" London Cyclopedia of Practical Medicine," article 
Puerperal Fever, 1833. 

Mr. Ceeley's Account of the Puerperal Fever at 
Aylesbury. " Lancet," 1835. 

Dr. Ramsbothain's Lecture. " London Medical Ga- 
zette," 1835. 

Mr. Yates Ackerly's Letter in the same Journal, 
1838. 

Mr. Ingleby on Epidemic Puerperal Fever. " Edin- 
burgh Medical and Surgical Journal," 1838. 

Mr. Paley's Letter. "London Medical Gazette," 
1839. 

Remarks at the Medical and Chirurgical Society. 
"Lancet," 1840. 

Dr. Rigby's " System of Midwifery." 1841. 

" Nunneley on Erysipelas," — a work which contains 
a large number of references on the subject. 1841^. 

"British and Foreign Quarterly Review," 1842. 

Dr. S. Jackson of Northumberland, as already quoted 
from the Summary of the College of Physicians, 1842. 

And lastly, a startling series of cases by Mr. Storrs 
of Doncaster, to be found in the "American Journal 
of the Medical Sciences " for January, 1843. . 

The relation of puerperal fever with other continued 
fevers would seem to be remote and rarely obvious. 
Hey refers to two cases of synochus occurring ioi the 



THE CONTAGIOUSNESS OF PUERPERAL FEVER. 165 

Royal Infirmary of Edinburgh, in women who had at- 
tended upon puerperal patients. Dr. Collins refers to 
several instances in which puerperal fever has appeared 
to originate from a continued proximity to patients 
suffering with typhus. 3 

Such occurrences as those just mentioned, though 
most important to be remembered and guarded against, 
hardly attract our notice in the midst of the gloomy 
facts by which they are surrounded. Of these facts, 
at the risk of fatiguing repetitions, I have summoned 
a sufficient number, as I believe, to convince the most 
incredulous that every attempt to disguise the truth 
which underlies them all is useless. 

It is true that some of the historians of the disease, 
especially Hulme, Hull, and Leake, in England ; Ton- 
nelle, Duges, and Baudelocque, in France, profess not 
to have found puerperal fever contagious. At the most 
they give us mere negative facts, worthless against an 
extent of evidence which now overlaps the widest range 
of doubt, and doubles upon itself in the redundancy 
of superfluous demonstration. Examined in detail, 
this and much of the show of testimony brought up to 
stare the daylight of conviction out of countenance, 
proves to be in a great measure unmeaning and inap- 
plicable, as might be easily shown were it necessary. 
Nor do I feel the necessity of enforcing the conclusion 
which arises spontaneously from the facts which have 
been enumerated, by formally citing the opinions of 
those grave authorities who have for the last half-cen- 
tury been sounding the unwelcome truth it has cost so 
many lives to establish. 

" It is to the British practitioner," says Dr. Rigby, 
" that we are indebted for strongly insisting upon 
a Treatise <>n Midwifery, p. 228. 



166 MEDICAL ESSAYS. 

this important and dangerous character of puerperal 
fever." ° 

The names of Gordon, John Clarke, Denman, Burns, 
Young, 6 Hamilton, Haighton, d Good, e Waller/ Blun- 
dell, Gooch, Ramsbotham, Douglas, 9 Lee, Ingleby, 
Locock/' Abercrombie/ Alison/ Travers/ Rigby, and 
Watson/ many of whose writings I have already re- 
ferred to, may have some influence with those who pre- 
fer the weight of authorities to the simple deductions 
of their own reason from the facts laid before them. 
A few Continental writers have adopted similar con- 
clusions." 1 It gives me pleasure to remember, that 
while the doctrine has been unceremoniously discred- 
ited in one of the leading Journals," and made very 
light of by teachers in two of the principal Medical 
Schools, of this country, Dr. Channing has for many 
years inculcated, and enforced by examples, the danger 
to be apprehended and the precautions to be taken in 
the disease under consideration. 

I have no wish to express any harsh feeling with re- 

" British and Foreign Med. Rev. for January, 1842. 
b Encyc. Britannica, xiii. 4(J7, art. "Medicine." 
" Outlines of Midwifery, p. 109. 
d Oral Lectun s, etc. 

* Study of Medicine, ii. 195. 

f Medical and Physical Journal, July, 1830. 
« Dublin lIosj>it(d Reports for 1822. 
h Library of Practical Medicine, i. 373. 

* Researches on Diseases of the Stomach, etc. p. 181. 
1 Library of Practical Medicine, i. 9fi. 

* Further Researches an Constitutional Irritation, p. 128. 
1 London Medical Gazette, February, 1842. 

m See British and Foreign Medical Il< mew, vol. iii. p. 525, and 
vol. iv. p. 517. Al>o Ed. Med. and Surg. Journal for July, 1824, 
and American Journal of Med. Sciences for January, 1841. 

n Phil. Med. Journal, vol. xii. p. 364. 



THE CONTAGIOUSNESS OF PUERPERAL FEVER. 167 

gard to the painful subject which has come before us. 
If there are any so far excited by the story of these 
dreadful events that they ask for some word of indig- 
nant remonstrance to show that science does not turn 
the hearts of its followers into ice or stone, let me re- 
mind them that such words have been uttered by those 
who speak with an authority I could not claim. It is 
as a lesson rather than as a reproach that I call up the 
memory of these irreparable errors and wrongs. No 
tongue can tell the heart-breaking calamity they have 
caused ; they have closed the eyes just opened upon a 
new world of love and happiness ; they have bowed 
the strength of manhood into the dust ; they have cast 
the helplessness of infancy into the stranger's arms, or 
bequeathed it, with less cruelty,- the death of its dying 
parent. There is no tone deep enough for regret, and 
no voice loud enough for warning. The woman about 
to become a mother, or with her new-born infant upon 
her bosom, should be the object of trembling care and 
sympathy wherever she bears her tender burden, or 
stretches her aching limbs. The very outcast of the 
streets has pity upon her sister in degradation, when 
the seal of promised maternity is impressed upon her. 
The remorseless vengeance of the law, brought down 
upon its victim by a machinery as sure as destiny, is 
arrested in its fall at a word which reveals her tran- 
sient claim for mercy. The solemn prayer of the lit- 
urgy singles out her sorrows from the multiplied trials 
of life, to plead for her in the hour of peril. God 
forbid that any member of the profession to which she 
trusts her life, doubly precious at that eventful period, 
should hazard it negligently, unadvisedly, or selfishly ! 
There may be some among those whom I address 

• Dr. Blundell and Dr. Rigby in the -works already cited. 



168 MEDICAL ESSAYS. 

who are disposed to ask the question, What course are 
we to follow in relation to this matter ? The facts are 
before them, and the answer must be left to their own 
judgment and conscience. If any should care to know 
my own conclusions, they are the following; and in 
taking- the liberty to state them very freely and broad- 
ly, I would ask the inquirer to examine them as freely 
in the light of the evidence which has been laid be- 
fore him. 

1. A physician holding himself in readiness to at- 
tend cases of midwifery should never take any active 
part in the post-mortem examination of cases of puer- 
peral fever. 

2. If a physician is present at such autopsies, he 
should use thorough ablution, change every article of 
dress, and allow twenty-four hours or more to elapse 
before attending to any case of midwifery. It may be 
well to extend the same caution to cases of simple per- 
itonitis. 

3. Similar precautions should be taken after the 
autopsy or surgical treatment of cases of erysipelas, 
if the physician is obliged to unite such offices with 
his obstetrical duties, which is in the highest degree 
inexpedient. 

4. On the occurrence of a single case of puerperal 
fever in his practice, the physician is bound to consider 
the next female he attends in labor, unless some weeks 
at least have elapsed, as in danger of being infected 
by him, and it is his duty to take every precaution to 
diminish her risk of disease and death. 

5. If within a short period two cases of puerperal 
fever happen close to each other, in the practice of the 
same physician, the disease not existing or prevailing 
in the neighborhood, he would do wisely to relinquish 



THE CONTAGIOUSNESS OF PUERPERAL FEVER. 169 

his obstetrical practice for at least one month, and 
endeavor to free himself by every available means 
from any noxious influence he may carry about with 
him. 

6. The occurrence of three or more closely con- 
nected cases, in the practice of one individual, no oth- 
ers existing in the neighborhood, and no other suffi- 
cient cause being alleged for the coincidence, is primd 
facie evidence that he is the vehicle of contagion. 

7. It is the duty of the physician to take every pre- 
caution that the disease shall not be introduced by 
nurses or other assistants, by making proper inquiries 
concerning them, and giving timely warning of every 
suspected source of danger. 

8. Whatever indulgence may be granted to those 
who have heretofore been the ignorant causes of so 
much misery, the time has come when the existence of 
a private pestilence in the sphere of a single physician 
should be looked upon, not as a misfortune, but a 
crime ; and in the knowledge of such occurrences the 
duties of the practitioner to his profession should give 
way to his paramount obligations to society. 

ADDITIONAL REFERENCES AND CASES. 

Fifth Annual Report of the Registrar- General of England, 

1843. Appendix. Letter from William Farr, Esq. — Several 
new series of cases are given in the Letter of Mr. Storrs, con- 
tained in the Appendix to this Report. Mr. Storrs suggests 
precautions similar to those I have laid down, and these pre- 
cautions are strongly enforced by Mr. Farr, who is, therefore, 
obnoxious to the same criticisms as myself. 

Hall and Dexter, in Am. Journal of Med. Sc. for January, 

1844. — Cases of puerperal fever seeming to originate in erysip- 
elas. 

Elkington, of Birmingham, in Provincial Med. Journal, cited 



170 MEDICAL ESSAYS. 

in Am. Journ. Med. Sc. for April, 1844. — Six cases in less than 
a fortnight, seeming to originate in a ease of erysipelas. 

West's Reports, in Brit, and For. Med. Review for October, 

1845, and January, 1847. — Affection of the arm, resembling 
malignant pustule, after removing the placenta of a patient who 
died from puerperal fever. Reference to cases at Wiirzburg, 
as proving contagion, and to Keiller's cases in the Monthly 
Journal for February, 1846, as showing connection of puerperal 
fever and erysipelas. 

Kneeland. — Contagiousness of Puerperal Fever. Am. Jour. 
Med. Sc, January, 1846. Also, Connection between Puerperal 
Fever and Epidemic Erysipelas. Ibid., April, 1846. 

Robert Storrs. — Contagious Effects of Puerperal Fever on the 
Male Subject; or on Persons not Child-bearing. (From Pro- 
vincial Med. and Surg. Journal.) Am. Jour. Med. Sc, January, 

1846. Numerous cases. See also Dr. Reid's case in same Jour- 
nal for April, 1846. 

Roulh't paper in Proc. of Royal Med. Chir. Soc, Am. Jour. 
Med. Sc, April, 1849, also in 13. and F. Med. Chir. Review, 
April, 1850. 

Hill, of Lenchars. — A Series of Cases illustrating the Conta- 
gious Nature of Erysipelas and of Puerperal Fever, and their 
Intimate Pathological Connection. (From Monthly Journal of 
Med. Sc.) Am. Jour. Med. Sc, July, 1850. 

Skoda on the Causes of Puerperal Fever. (Peritonitis in rab- 
bits, from inoculation with different morbid secretions.) Am. 
Jour. Med. Sc, October, 1850. 

Arueth. — Paper read before the National Academy of Medi- 
cine. AniKiles d* Hygiene, Tome LXV. 2° Partie. (Means of 
Disinfection proposed by M. " Semmeliveis M (Semmelwciss.) 
Lotions of chloride of lime and use of nail-brush before admis- 
sion to lying-in wards. Alleged sudden and great decrease of 
mortality from puerperal fever. Cause of disease attributed to 
inoculation with cadaveric matters.) See also Routh's paper, 
mentioned above. 

Moir. — Remarks at a meeting of the Edinburgh Medico-Chi- 
rnrgical Society. Refers to cases of Dr. Kellie, of Leith Six- 
teen in succession, all j'niaL Also to several instances of 
individual pupils having had a succession of cases in various 
quarters of the town, while others, practising as extensively in 
the same localities, had none. Also to several special cases not 






THE CONTAGIOUSNESS OF PUERPERAL FEVER. 171 

mentioned elsewhere. Am. Jour. Med. Sc. for October, 1851. 
(From New Monthly Journal of Med. Science.) 

Simpson. — Observations at a Meeting of the Edinburgh Ob- 
stetrical Society. (An "eminent gentleman," according to Dr. 
Meigs, whose u name is as well known in America as in (his) 
native land." Obstetrics. Phil. 1852, pp. 368, 375.) The stu- 
dent is referred to this paper for a valuable resume oi many of 
the facts, and the necessary inferences, relating to this subject. 
Also for another series of cases, Mr. Sidey's, five or six in rapid 
succession. Dr. Simpson attended the dissection of two of Dr. 
Sidey's cases, and freely handled the diseased parts. His next 
four child-bed patients were affected with puerperal fever, and 
it was the first time he had seen it in practice. As Dr. Simpson 
is a gentleman (Dr. Meigs, as above), and as " a gentleman's 
hands are clean " (Dr. Meigs' Sixth Letter), it follows that a 
gentleman with clean hands may carry the disease. Am. Jour. 
Med. Sc, October, 1851. 

Peddle. — The five or six cases of Dr. Sidey, followed by the 
four of Dr. Simpson, did not end the series. A practitioner in 
Leith having examined in Dr. Simpson's house, a portion of the 
uterus obtained from one of the patients, had immediately after- 
wards three fatal cases of puerperal fever. Dr. Peddie referred 
to two distinct series of consecutive cases in his own practice. 
He had since taken precautions, and not met with any such 
cases. Am. Jour. Med. Sc, October, 1851. 

Copland. — Considers it proved that puerperal fever may be 
propagated by the hands and the clothes, or either, of a third 
person, the bed-clothes or body-clothes of a patient. Mentions 
a new series of cases, one of which he saw, with the practitioner 
who had attended them. She was the sixth he had had within 
a few days. All died. Dr. Copland insisted that contagion had 
caused these cases ; advised precautionary measures, and the 
practitioner had no other cases for a considerable time. Con- 
siders it criminal, after the evidence adduced, — which he could 
have quadrupled, — and the weight of authority brought for- 
ward, for a practitioner to be the medium of transmitting con- 
tagion and death to his patients. Dr. Copland lays down rules 
similar to those suggested by myself, and is therefore entitled to 
the same epithet for so doing. Medical Dictionary, New York, 
1852. Article, Puerperal States and Diseases. 

If there is any appetite for facts so craving as to be yet unap- 



172 MEDICAL ESSAYS. 

peased, — lassaia, necdum satiata, — more can be obtained. Dr. 
Hodge remarks that " the frequency and importance of this sin- 
gular circumstance (that the disease is occasionally more prev- 
alent with one practitioner than another) has been exceedingly 
overrated." More than thirty strings of cases, more than two 
hundred and fifty sufferers from puerperal fever, more than one 
hundred and thirty deaths appear as the results of a sparing es- 
timate of such among the facts I have gleaned as could be nu- 
merically valued. These facts constitute, we may take it for 
granted, but a small fraction of those that have actually occurred. 
The number of them might be greater, but " 't is enough, 't will 
serve," in Mercutio's modest phrase, so far as frequency is con- 
cerned. For a just estimate of the importance of the singular 
circumstance, it might be proper to consult the languid surviv- 
ors, the widowed husbands, and the motherless children, as 
well as "the unfortunate accoucheur." 



III. 

CURRENTS AND COUNTER-CURRENTS IN MEDI- 
CAL SCIENCE.* 

" Uovcrwv (pvcries Irirpoi " 

" Facilitate magis quam violentia." 

Hippocrates. 

Our Annual Meeting never fails to teach us at least 
one lesson. The art whose province it is to heal and 
to save cannot protect its own ranks from the inroads 
of disease and the waste of the Destroyer. 

Seventeen of our associates have been taken from us 
since our last Anniversary. Most of them followed 
their calling in the villages or towns that lie among 
the hills or along the inland streams. Only those who 
have lived the kindly, mutually dependent life of the 
country, can tell how near the physician who is the 
main reliance in sickness of all the families through- 
out a thinly settled region comes to the hearts of the 
people among whom he labors, how they value him 
while living, how they cherish his memory when dead. 
For these friends of ours who have gone before, there 
is now no more toil; they start from their slum- 
bers no more at the cry of pain ; they sally forth no 
more into the storms ; they ride no longer over the 
lonely roads that knew them so well ; their wheels are 
rusting on their axles or rolling with other burdens ; 

° An Address delivered before the Massachusetts Medical 
Society, at the Annual Meeting, May 30, I860. 



174 MEDICAL ESSAYS. 

their watchful eyes are closed to all the sorrows they 
lived to soothe. Not one of these was famous in the 
great world ; some were almost unknown beyond their 
own immediate circle. But they have left behind them 
that loving remembrance which is better than fame, 
and if their epitaphs are chiselled briefly in stone, they 
are written at full length on living tablets in a thou- 
sand homes to which they carried their ever-welcome 
aid and sympathy. 

One whom we have lost, very widely known and 
honored, was a leading practitioner of this city. His 
image can hardly be dimmed in your recollection, as 
he stood before you only three years ago, filling the 
same place with which I am now honored. To speak 
of him at all worthily, would be to write the history of 
professional success, won without special aid at starting, 
by toil, patience, good sense, pure character, and pleas- 
ing manners ; won in a straight uphill ascent, without 
one breathing-space until he sat down, not to rest, but 
to die. If prayers could have shielded him from the 
stroke, if love could have drawn forth the weapon, and 
skill could have healed the wound, this passing tribute 
might have been left to other lips and to another gen- 
eration. 

Let us hope that our dead have at last found that 
rest which neither summer nor winter, nor day nor 
night, had granted to their unending earthly labors ! 
And let us remember that our duties to our brethren 
do not cease when they become unable to share our 
toils, or leave behind them in want and w r oe those whom 
their labor had supported. It is honorable to the Pro- 
fession that it has organized an Association ° for the 
relief of its suffering members and their families ; i{ 
a The Massachusetts Medical Benevolent Society. 



CURRENTS AND COUNTER-CURRENTS. 175 

owes this tribute to the ill-rewarded industry and sac- 
rifices of its less fortunate brothers who wear out health 
and life in the service of humanity. I have great 
pleasure in referring to this excellent movement, which 
gives our liberal profession a chance to show its liber- 
ality, and serves to unite us all, the successful and 
those whom fortune has cast down, in the bonds of a 
true brotherhood. 

A medical man, as he goes about his daily business 
after twenty years of practice, is apt to suppose that he 
treats his patients according to the teachings of his ex- 
perience. No doubt this is true to some extent ; to 
what extent depending much on the qualities of the in- 
dividual. But it is easy to prove that the prescriptions 
of even wise physicians are very commonly founded on 
something quite different from experience. Experience 
must be based on the permanent facts of nature. But 
a glance at the prevalent modes of treatment of any 
two successive generations will show that there is a 
changeable as well as a permanent element in the art 
of healing ; not merely changeable as diseases vary, or 
as new remedies are introduced, but changeable by the 
going out of fashion of special remedies, by the deca- 
dence of a popular theory from which their fitness was 
deduced, or other cause not more significant. There is 
no reason to suppose that the present time is essentially 
different in this respect from any other. Much, there- 
fore, which is now very commonly considered to be the 
result of experience, will be recognized in the next, or 
in some succeeding generation, as no such result at all, 
but as a foregone conclusion, based on some prevalent 
belief or fashion of the time. 

There are, of course, in every calling, those who go 



176 MEDICAL ESSAYS. 

about the work of the day before them, doing it ac- 
cording to the rules of their craft, and asking no ques- 
tions of the past or of the future, or of the aim and 
end to which their special labor is contributing. These 
often consider and call themselves practical men. 
They pull the oars of society, and have no leisure to 
watch the currents running this or that way ; let theo- 
rists and philosophers attend to them. In the mean 
time, however, these currents are carrying the practical 
men, too, and all their work may be thrown away, and 
worse than thrown away, if they do not take knowl- 
edge of them and get out of the wrong ones and into 
the right ones as soon as they may. Sir Edward Parry 
and his party were going straight towards the pole in 
one of their arctic expeditions, travelling at the rate of 
ten miles a day. But the ice over which they travelled 
was drifting straight towards the equator, at the rate of 
ticelve miles a day, and yet no man among them would 
have known that he was travelling two miles a clay 
backward unless he had lifted his eyes from the track in 
which he was plodding. It is not only going backward 
that the plain practical workman is liable to, if he will 
not look up and look around ; he may go forward to 
ends he little dreams of. It is a simple business for a 
mason to build up a niche in a wall ; but what if, a 
hundred years afterwards when the wall is torn down, 
the skeleton of a murdered man drop out of the niche ? 
It was a plain practical piece of carpentry for a Jew- 
ish artisan to fit two pieces of timber together accord- 
ing to the legal pattern in the time of Pontius Pilate ; 
he asked no questions, perhaps, but we know what 
burden the cross bore on the morrow ! And so, with 
subtler tools than trowels or axes, the statesman who 
works in policy without principle, the theologian who 



CURRENTS AND COUNTER-CURRENTS. 177 

works in forms without a soul, the physician who, 
calling himself a practical man, refuses to recognize 
the larger laws which govern his changing practice, 
may all find, that they have been building truth into 
the wall, and. hanging humanity upon the cross. 

The truth is, that medicine, professedly founded on 
observation, is as sensitive to outside influences, polit- 
ical, religious, philosophical, imaginative, as is the ba- 
rometer to the changes of atmospheric density. The- 
oretically it ought to go on its own straightforward 
inductive path, without regard to changes of govern- 
ment or to fluctuations of public opinion. But look 
a moment while I clash a few facts together, and see 
if some sparks do not reveal by their light a closer 
relation between the Medical Sciences and the con- 
ditions of Society and the general thought of the time, 
than would at first be suspected. 

Observe the coincidences between certain great po- 
litical and intellectual periods and the appearance of 
illustrious medical reformers and teachers. It was in 
the age of Pericles, of Socrates, of Plato, of Phidias, 
that Hippocrates gave to medical knowledge the form 
which it retained for twenty centuries. With the world- 
conquering Alexander, the world-embracing Aristotle, 
appropriating anatomy and physiology, among his 
manifold spoils of study, marched abreast of his royal 
pupil to wider conquests. Under the same Ptolemies 
who founded the Alexandrian Library and Museum, 
and ordered the Septuagint version of the Hebrew 
Scriptures, the infallible Herophilus a made those six 
hundred dissections of which Tertullian accused him, 
and the sagacious Erasistratus introduced his mild 

° " Contradicere Herophilo in anatomicis, est contradicere 
evangelium," was a saying of Fallopius. 



178 MEDICAL ESSAYS. 

antiphlogistic treatment in opposition to the polyphar- 
macy and antidotal practice of his time. It is signifi- 
cant that the large-minded Galen should have been 
the physician and friend of the imperial philosopher 
Marcus Aurelius. The Arabs gave laws in various 
branches of knowledge to those whom their arms had 
invaded, or the terror of their spreading dominion had 
reached, and the point from which they started was, 
as Humboldt acknowledges, "the study of medicine, 
by which they long ruled the Christian Schools," a 
and to which they added the department of chemical 
pharmacy. 

Look at Vesalius, the contemporary of Luther. 
Who can fail to see one common spirit in the radical 
ecclesiastic and the reforming court-physician ? Both 
still to some extent under the dominion of the letter : 
Luther holding to the real presence ; Vesalius actually 
causing to be drawn and engraved two muscles which 
he knew were not found in the human subject, be- 
cause they had been described by Galen, from dissec- 
tions of the lower animals. 6 Both breaking through 
old traditions in the search of truth ; one, knife in 
hand, at the risk of life and reputation, the other at 
the risk of fire and fagot, with that mightier weapon 
which all the devils could not silence, though they had 
been thicker than the tiles on the house-tops. How 
much the physician of the Catholic Charles V. had in 
common with the great religious destructive, may be 
guessed by the relish with which he tells the story how 
certain Pavian students exhumed the body of an " ele- 
gans scortum," or lovely dame of ill repute, the favor- 

° Cosmos, ii. 587. 

6 Opera Omnia, Basileae, 1555. Lib. II. tab. V., VI. pp. 225, 
228. 



CURRENTS AND COUNTER-CURRENTS. 179 

ite of a monk of the order of St. Anthony, who does 
not seem to have resisted temptation so well as the 
founder of his order." We have always ranked the 
physician Rabelais among the early reformers, but I 
do not know that Vesalius has ever been thanked for 
his hit at the morals of the religious orders, or for 
turning to the good of science what was intended for 
the " benefit of clergy." 

Our unfortunate medical brother, Michael Servetus, 
the spiritual patient to whom the theological moxa was 
applied over the entire surface for the cure of his her- 
esy, came very near anticipating Harvey. 6 The same 
quickened thought of the time which led him to dis- 
pute the dogma of the Church, opened his mind to the 
facts which contradicted the dogmas of the Faculty. 

Harvey himself was but the -posthumous child of 
the great Elizabethan period. Bacon was at once his 
teacher and his patient. The founder of the new in- 
ductive philosophy had only been dead two years 
when the treatise on the Circulation, the first-fruit of 
the Restoration of Science, was given to the world. 

And is it to be looked at as a mere accidental coin- 
cidence, that while Napoleon was modernizing the po- 
litical world, Bichat was revolutionizing the science of 
life and the art that is based upon it ; that while the 
young general was scaling the Alps, the young sur- 
geon was climbing the steeper summits of unexplored 

° Opera Omnia, Basilese, 1555. Lib. V. cap. 15, p. 663. 

6 " Non per parietem cordis mediam, ut vulgo creditur, sed 
magno artificio, a dextro cordis ventriculo, longe per pulmones 
tractu, et a vena arteriosa, in arteriam venosam transfunditur." 
— Bostock's Physiology, note to p. 211. I cite the passage on 
account of the calling in question of the claims of Servetus by 
Amed.ee Pichot. Life and Labors of Sir Charles Bell, London, 
1860, p. 3. 



180 MEDICAL ESSAYS. 

nature ; that the same year read the announcement of 
those admirable " Researches on Life and Death," and 
the bulletins of the battle of Marengo ? 

If we come to our own country, who can fail to rec- 
ognize that Benjamin Rush, the most conspicuous of 
American physicians, was the intellectual offspring of 
the movement which produced the Revolution ? " The 
same hand," says one of his biographers, " which sub- 
scribed the declaration of the political independence of 
these States, accomplished their emancipation from 
medical systems formed in foreign countries, and 
wholly unsuitable to the state of diseases in America." 

Following this general course of remark, I propose 
to indicate in a few words the direction of the main 
intellectual current of the time, and to point out more 
particularly some of the eddies which tend to keep the 
science and art of medicine from moving with it, or 
even to carry them backwards. 

The two dominant words of our time are law and 
average, both pointing to the uniformity of the order 
of being in which we live. Statistics have tabulated 
everything, — population, growth, wealth, crime, dis- 
ease. We have shaded maps showing the geographical 
distribution of larceny and suicide. Analysis and 
classification have been at work upon all tangible and 
visible objects. The Positive Philosophy of Comte has 
only given expression to the observing and computing 
mind of the nineteenth century. 

In the mean time, the great stronghold of intellect- 
ual conservatism, traditional belief, has been assailed 
by facts which would have been indicted as blasjuiemy 
but a few generations ago. Those new tables of the 
law, placed in the hands of the geologist by the same 



CURRENTS AND COUNTER-CURRENTS. 181 

living God who spoke from Sinai to the Israelites of 
old, have remodelled the beliefs of half the civilized 
world. The solemn scepticism of science has replaced 
the sneering doubts of witty philosophers. The more 
positive knowledge we gain, the more we incline to 
question all that has been received without absolute 
proof. 

As a matter of course, this movement has its partial 
reactions. The province of faith is claimed as a port 
free of entry to unsupported individual convictions. 
The tendency to question is met by the unanalyzing 
instinct of reverence. The old church calls back its 
frightened truants. Some who have lost their hered- 
itary religious belief find a resource in the revelations 
of Spiritualism. By a parallel movement, some of 
those who have become medical infidels pass over to 
the mystic band of believers in the fancied miracles of 
Homoeopathy. 

Under these influences transmitted to, or at least 
shared by, the medical profession, the old question be- 
tween " Nature," so called, and " Art," or professional 
tradition, has reappeared with new interest. I say the 
old question, for Hippocrates stated the case on the 
side of " Nature " more than two thousand years ago. a 
Miss Florence Nightingale, — and if I name her next 
to the august Father of the Healing Art, its noblest 
daughter well deserves that place of honor, — Miss 
Florence Nightingale begins her late volume with a 
paraphrase of his statement. But from a very early 
time to this there has always been a strong party 
against "Nature." Themison called the practice of 
Hippocrates " a meditation upon death." Dr. Rush 
says : " It is impossible to calculate the mischief which 
a Epidemics, book vi. sect. 5. 



182 MEDICAL ESSAYS. 

Hippocrates has done, by first marking Nature with his 
name and afterwards letting her loose upon sick peo- 
ple. Millions have perished by her hands in all ages 
and countries." Sir John Forbes, whose defence of 
" Nature " in disease you all know, and to the testi- 
monial in whose honor four of your Presidents have 
contributed, has been recently greeted, on retiring 
from the profession, with a wish that his retirement 
had been twenty years sooner, and the opinion that no 
man had done so much to destroy the confidence of the 
public in the medical profession. 

In this Society we have had the Hippocratic and the 
Themisonic side fairly represented. The treatise of 
one of your early Presidents on the Mercurial Treat- 
ment is familiar to my older listeners. Others who 
have held the same office have been noted for the bold- 
ness of thjeir practice, and even for partiality to the 
use of complex medication. 

On the side of " Nature " we have had, first of all, 
that remarkable discourse on Self-Limited Diseases, 
which has given the key-note to the prevailing medical 
tendency of this neighborhood, at least, for the quarter 
of a century since it was delivered. Nor have we 
forgotten the address delivered at Springfield twenty 
years later, 6 full of good sense and useful suggestions, 
to one of which suggestions we owe the learned, im- 
partial, judicious, well-written Prize Essay of Dr. Wor- 
thington Hooker. We should not omit from the list 

° On Self- Limited Diseases. A Discourse delivered before the 
Massachusetts Medical Society, at their Annual Meeting, May 
27, 1835. By Jacob Bigelow, M. I). 

6 Search out the Secrets of Nature. By Augustus A. Gould, 
M. D. Read at the Annual Meeting, June 27, 1855. 

c Rational Therapt utics. A Prize Essay. By Worthington 
Hooker, M. D., of M ew Haven. Boston. 1857. 



CURRENTS AND COUNTER-CURRENTS. 183 

the important address of another of our colleagues,** 
showing by numerous cases the power of Nature in 
healing compound fractures to be much greater than 
is frequently supposed, — affording, indeed, more strik- 
ing illustrations than can be obtained from the history 
of visceral disease, of the supreme wisdom, forethought, 
and adaptive dexterity of that divine Architect, as 
shown in repairing the shattered columns which sup- 
port the living temple of the body. 

We who are on the side of " Nature " please our- 
selves with the idea that we are in the great current 
in which the true intelligence of the time is moving. 
We believe that some who oppose, or fear, or de- 
nounce our movement are themselves caught in vari- 
ous eddies that set back against the truth. And we do 
most earnestly desire and most actively strive, that 
Medicine, which, it is painful to remember, has been 
spoken of as " the withered branch of science " at a 
meeting of the British Association, shall be at length 
brought fully to share, if not to lead, the great wave 
of knowledge which rolls with the tides that circle the 
globe. 

If there is any State or city which might claim to 
be the American headquarters of the nature-trusting 
heresy, provided it be one, that State is Massachusetts, 
and that city is its capital. The effect which these 
doctrines have upon the confidence reposed in the pro- 
fession is a matter of opinion. For myself, I do not 
believe this confidence can be impaired by any investi- 
gations which tend to limit the application of trouble- 
some, painful, uncertain, or dangerous remedies. Nay, 

° On the Treatment of Compound and Complicated Fractures. 
By William J. Walker, M. D. Read at the Annual Meeting, 
May 29, 1845. 



184 MEDICAL ESSAYS. 

I will venture to say this, tliat if every specific were to 
fail utterly, if the cinchona trees all died out, and the 
arsenic mines were exhausted, and the sulphur regions 
were burned up, if every drug from the vegetable, ani- 
mal, and mineral kingdom were to disappear from the 
market, a body of enlightened men, organized as a dis- 
tinct profession, would be required just as much as 
now, and respected and trusted as now, whose province 
should be to guard against the causes of disease, to 
eliminate them if possible when still present, to order 
all the conditions of the patient so as to favor the ef- 
forts of the system to right itself, and to give those 
predictions of the course of disease winch only experi- 
ence can warrant, and which in so many cases relieve 
the exaggerated fears of sufferers and their friends, or 
warn them in season of impending danger. Great as 
the loss would be if certain active remedies could no 
longer be obtained, it would leave the medical profes- 
sion the most essential part of its duties, and all, and 
more than all, its present share of honors ; for it would 
be the death-blow to charlatanism, which depends for 
its success almost entirely on drugs, or at least on a 
nomenclature that suggests them. 

There is no offence, then, or danger in expressing 
the opinion, that, after all which has been said, the 
community is still overdosed. The best proof of it is, 
that no families take so little medicine as those of doc- 
tors, except those of apothecaries, and that old practi- 
tioners are more sparing of active medicines than 
younger ones. a The conclusion from these facts is one 

a Dr. James Jackson has kindly permitted me to make the 
following extract from a letter just received by him from Sir 
James Clark, and dated May 2G, 1860: — 

11 As a physician advances in age, he generally, I think, places 



CURRENTS AND COUNTER-CURRENTS. 185 

which the least promising of Dr. Howe's pupils in the 
mental department could hardly help drawing. 

Part of the blame of over-medication must, I fear, 
rest with the profession, for yielding to the tendency 
to self-delusion, which seems inseparable from the 
practice of the art of healing. I need only touch on 
the common modes of misunderstanding or misapply- 
ing the evidence of nature. 

First, there is the natural incapacity for sound ob- 
servation, which is like a faulty ear in music. We see 
this in many persons who know a good deal about 
books, but who are not sharp-sighted enough to buy a 
horse or deal with human diseases. 

Secondly, there is in some persons a singular inabil- 
ity to weigh the value of testimony ; of which, I think, 
from a pretty careful examination of his books, Hahn- 
emann affords the best specimen outside the walls of 
Bedlam. 

The inveterate logical errors to which physicians 
have always been subject are chiefly these : — 

The mode of inference per enumerationem simpli- 
cem, in scholastic phrase ; that is, counting only their 
favorable cases. This is the old trick illustrated in 
Lord Bacon's story of the gifts of the shipwrecked 
people, hung up in the temple. — Behold ! they vowed 
these gifts to the altar, and the gods saved them. Ay, 
said a doubting bystander, but how many made vows 
of gifts and were shipwrecked notwithstanding ? The 
numerical system is the best corrective of this and sim- 
ilar errors. The arguments commonly brought against 
its application to all matters of medical observation, 
treatment included, seem to apply rather to the tabu- 
less confidence in the ordinary medical treatment tlian he did, 
not only during his early, but even his middle period of life." 



186 MEDICAL ESSAYS. 

lation of facts ill observed, or improperly classified, 
than to the method itself. 

The post hoc ergo propter hoc error : he got well 
after taking my medicine ; therefore in consequence of 
taking it. 

The false induction from genuine facts of observa- 
tion, leading to the construction of theories which are 
then deductively applied in the face of the results of 
direct observation. The school of Broussais has fur- 
nished us with a good example of this error. 

And lastly, the error which Sir Thomas Browne 
calls giving " a reason of the golden tooth ; " that is, 
assuming a falsehood as a fact, and giving reasons for 
it, commonly fanciful ones, as is constantly done by 
that class of incompetent observers who find their 
" golden tooth " in the fabulous effects of the homoeo- 
pathic materia medica, — which consists of sugar of 
milk and a nomenclature. 

Another portion of the blame rests with the public 
itself, which insists on being poisoned. Somebody 
buys all the quack medicines that build palaces for the 
mushroom, say rather, the toadstool millionaires. Who 
is it ? These people have a constituency of millions. 
The popular belief is all but universal that sick per- 
sons should feed on noxious substances. One of our 
members was called not long since to a man with a 
terribly sore mouth. On inquiry he found that the 
man had picked up a box of unknown pills, in Howard 
Street, and had proceeded to take them, on general 
principles, pills being good for people. They hap- 
pened to contain mercury, and hence the trouble for 
which he consulted our associate. 

The outside pressure, therefore, is immense upon 
the physician, tending to force him to active treatment 



nfcj 



CURRENTS AND COUNTER-CURRENTS. 187 

of some kind. Certain old superstitions, still linger- 
ing in the mind of the public, and not yet utterly ex- 
pelled from that of the profession, are at the bottom 
of this, or contribute to it largely. One of the most 
ancient is, that disease is a malignant agency, or enti- 
ty, to be driven out of the body by offensive substances, 
as the smoke of the fish's heart and liver drove the 
devil out of Tobit's bridal chamber, according to the 
Apochrypha. Epileptics used to suck the blood from 
the wounds of dying gladiators." The Hon. Robert 
Boyle's little book was published some twenty or thirty 
years before our late President, Dr. Holyoke, was born. 6 
In it he recommends, as internal medicines, most of 
the substances commonly used as fertilizers of the soil. 
His "Album Graecuni" is best left untranslated, and his 
"Zebethum Occidentale " is still more transcendentally 
unmentionable except in a strange dialect. It sounds 
odiously to us to hear hini recommend for dysentery a 
powder made from " the sole of an old shoe worn by 
some man that walks much." Perhaps nobody here 
ever heard of tying a stocking, which had been worn 
during the day, round the neck at night for a sore 
throat. The same idea of virtue in unlovely secre- 
tions ! c 

Even now the Homceopathists have been introducing 
the venom of serpents, under the learned title of 
Lachesis, and outraging human nature with infusions 
of the pedicidus capitis ; that is, of course, as we 
understand their dilutions, the names of these things ; 

° Plinii Hist. Mundi. lib. xxviii. c. 4. 

6 A Collection of Choice and Safe Remedies. The Fifth Edi- 
tion, corrected. London, 1712. Dr. Holyoke was born in 1728. 

c The idea is very ancient. " Sordes hominis " — " Sudore et 
oleo medicinam facientibus." — Plin. xxviii. 4. 



188 MEDICAL ESSAYS. 

for if a fine-tooth-comb insect were drowned in Lake 
Superior, we cannot agree with them in thinking that 
every drop of its waters would be impregnated with 
all the pedicular virtues they so highly value. They 
know what they are doing. They are appealing to 
the detestable old superstitious presumption in favor 
of whatever is nauseous and noxious as being good for 
the sick. 

Again, we all occasionally meet persons stained with 
nitrate of silver, given for epilepsy. Read what Dr. 
Martin says, about the way in which it came to be 
used, in his excellent address before the Norfolk 
County Medical Society, and the evidence I can show, 
but have not time for now, and then say what you 
think of the practice which on such presumptions turns 
a white man as blue as the double-tattooed King of 
the Cannibal Islands! [Note A.~\ 

If medical superstitions have fought their way down 
through all the rationalism and seej>ticism of the nine- 
teenth century, of course the theories of the schools, 
supported by great names, adopted into the popular 
belief and incorporated with the general mass of mis- 
apprehension with reference to disease, must be ex- 
pected to meet us at every turn in the shape of bad 
practice founded on false doctrine. A French patient 
complains that his blood heats him, and expects his 
doctor to bleed him. An English or American one 
says he is bilious, and will not be easy without a dose 
of calomel. A doctor looks at a patient's tongue, sees 
it coated, and says the stomach is foul ; his head full 
of the old saburral notion which the extreme inflam- 
mation-doctrine of Broussais did so much to root out, 
but which still leads, probably, to much needless and 
injurious wrong of the stomach and bowels by evacu- 



CURRENTS AND COUNTER-CURRENTS. 189 

ants, when all they want is to be let alone. It is so 
hard to get anything ont of the dead hand of medical 
tradition ! The mortmain of theorists extinct in sci- 
ence clings as close as that of ecclesiastics defunct in 
law. 

One practical hint may not be out of place here. It 
seems to be sometimes forgotten, by those who must 
know the fact, that the tongue is very different, ana- 
tomically and physiologically, from the stomach. Its 
condition does not in the least imply a similar one of 
the stomach, which is a very different structure, cov- 
ered with a different land of epithelium, and furnished 
with entirely different secretions. A silversmith will, 
for a dollar, make a small hoe, of solid silver, which 
will last for centuries, and will give a patient more 
comfort, used for the removal of the accumulated epi- 
thelium and fungous growths which constitute the 
" fur," than many a prescription with a splitfooted B/ 
before it, addressed to the parts out of reach. 

I think more of this little implement on account of 
its agency in saving the Colony at Plymouth in the 
year 1623. Edward Winslow heard that Massasoit 
was sick and like to die. He foimd him with a house- 
ful of people about him, women rubbing his arms and 
legs, and friends " making such a hellish noise " as 
they probably thought would scare away the devil of 
sickness. Winslow gave him some conserve, washed 
his mouth, scraped his tongue, which was in a horrid 
state, got down some drink, made him some broth, 
dosed him with an infusion of strawberry leaves and 
sassafras root, and had the satisfaction of seeing him 
rapidly recover. Massasoit, full of gratitude, revealed 
the plot which had been formed to destroy the colo- 
nists, whereupon the Governor ordered Captain Miles 



190 MEDICAL ESSAYS. 

Standish to see to them ; who thereupon, as everybody 
remembers, stabbed Pecksuot with his own knife, broke 
up the plot, saved the colony, and thus rendered Mas- 
sachusetts and the Massachusetts Medical Society a 
possibility, as they now are a fact before us.° So much 
for tins parenthesis of the tongue-scraper, which helped 
to save the young colony from a much more serious 
scrape, and may save the Union yet, if a Presidential 
candidate should happen to be taken sick as Massasoit 
was, and his tongue wanted cleaning, — which process 
would not hurt a good many politicians, with or with- 
out a typhoid fever. 

Again, see how the " bilious " theory works in 
every-day life here and now, illustrated by a case from 
actual life. A youthful practitioner, whose last molars 
have not been a great while cut, meets an experienced 
and noted physician in considtation. This is the case. 
A slender, lymphatic young woman is suckling two 
lusty twins, the intervals of suction being occupied on 
her part with palpitations, headaches, giddiness, throb- 
bing in the head, and various nervous symptoms, her 
cheeks meantime getting bloodless, and her strength 
running away in company with her milk. The old ex- 
perienced physician, seeing the yellowish waxy look 
which is common in anaemic patients, considers it a 
" bilious " case, and is for giving a rousing emetic. 
Of course, he has to be wheedled out of this, a recipe 
is written for beefsteaks and porter, the twins are 
ignominiously expelled from the anaemic bosom, and 
forced to take prematurely to the bottle, and this pro- 
lific mother is saved for future usefulness in the line 
of maternity. 

a Window's Good News from New England, or a Relation, etc, 
chap. 20, 21. 



CURRENTS AND COUNTER-CURRENTS. 191 

The practice of making a profit on the medicine 
ordered has been held up to reprobation by one at 
least of the orators who have preceded me. That the 
effect of this has been ruinous in English practice I 
cannot doubt, and that in this country the standard of 
practice was in former generations lowered through 
the same agency is not unlikely. I have seen an old 
account-book in which the physician charged an extra 
price for gilding his rich patients' pills. If all medi- 
cine were very costly, and the expense of it always 
came out of the physician's fee, it would really be a 
less objectionable arrangement than this other most per- 
nicious one. He would naturally think twice before 
he gave an emetic or cathartic which evacuated his 
own pocket, and be sparing of the cholagogues that 
emptied the biliary ducts of his own wallet, unless he 
were sure they were needed. If there is any temptation, 
it should not be in favor of giving noxious agents, as 
it clearly must be in the case of English druggists and 
" General Practitioners." The complaint against the 
other course is a very old one. Pliny, inspired with 
as truly Roman a horror of quackery as the elder 
Cato, — who declared that the Greek doctors had 
sworn to exterminate ail barbarians, including the 
Romans, with their drugs, but is said to have phy- 
sicked his own wife to death, notwithstanding, — Pliny 
says, in so many words, that the cerates and cata- 
plasms, plasters, collyria, and antidotes, so abundant 
in his time, as in more recent days, were mere tricks 
to make money. 

A pretty strong eddy, then, or rather many eddies, 
setting constantly back from the current of sober ob- 
servation of nature, in the direction of old superstitions 



192 MEDICAL ESSAYS. 

and fancies, of exploded theories, of old ways of making 
money, which are very slow to pass out of fashion! 
But there are other special American influences which 
we are bound to take cognizance of. If I wished to 
show a student the difficulties of getting at truth from 
medical experience, I would give him the history of 
epilepsy to read. If I wished him to understand the 
tendencies of the American medical mind, its sanguine 
enterprise, its self-confidence, its audacious handling of 
Nature, its impatience with her old-fashioned ways of 
taking time to get a sick man well, I would make him 
read the life and writings of Benjamin Rush. Dr. 
Eush thought and said that there were twenty times 
more intellect and a hundred times more knowledge in 
the country in 1799 than before the Revolution. °His 
own mind was in a perpetual state of exaltation pro- 
duced by the stirring scenes in which he had taken a 
part, and the quickened life of the time in which he 
lived. It was not the state to favor sound, calm obser- 
vation. He was impatient, and Nature is profoundly 
imperturbable. We may adjust the beating of our 
hearts to her pendulum if we will and can, but we may 
be very sure that she will not change the pendulum's 
rate of going because our hearts are palpitating. He 
thought he had mastered yellow-fever. " Thank God," 
he said, " out of one hundred patients whom I have 
visited or prescribed for this day, I have lost none." 
Where was all his legacy of knowledge when Norfolk 
was decimated? Where was it when the blue flies 
were buzzing over the coffins of the unburied dead 
piled up in the cemetery of New Orleans, at the edge 
of the huge trenches yawning to receive them ? 

One such instance will do as well as twenty. Dr. 
Rush must have been a charming teacher, as he was an 



CURRENTS AND COUNTER-CURRENTS. 193 

admirable man. He was observing, rather than a 
sound observer ; eminently observing, curious, even, 
about all manner of things. But he could not help 
feeling as if Nature had been a good deal shaken by 
the Declaration of Independence, and that American 
art was getting to be rather too much for her, — es- 
pecially as illustrated in his own practice. He taught 
thousands of American students, he gave a direction to 
the medical mind of the country more than any other 
one man ; perhaps he typifies it better than any other. 
It has clearly tended to extravagance in remedies and 
trust in remedies, as in everything else. How could a 
people which has a revolution once in four years, which 
has contrived the Bowie-knife and the revolver, which 
has chewed the juice out of all the superlatives in the 
language in Fourth of July orations, and so used up 
its epithets in the rhetoric of abuse that it takes two 
great quarto dictionaries to supply the demand ; which 
insists in sending out yachts and horses and boys to 
out-sail, out-run, out-fight, and checkmate all the rest 
of creation ; how could such a people be content with 
any but " heroic " practice ? What wonder that the 
stars and stripes wave over doses of ninety grains of 
sulphate of quinine," and that the American eagle 
screams with delight to see three drachms of calomel 
given at a single mouthful ? 6 

Add to this the great number of Medical Journals, 
all useful, we hope, most of them necessary, we trust, 

a More strictly, ninety-six grains in two hours. — Dunglison's 
Practice, 1842, vol. ii. p. 520. Eighty grains in one dose. — 
Ibid. p. 53G. Ninety-six grains of sulphate of quinine are equal 
to eight ounces of good bark. — Wood 8f Buche. 

b Pereira, ii. 614. Quoted from Christison's Treatise on Poi' 
sons. 

13 



194 MEDICAL ESSAYS. 

many of them excellently well conducted, but which 
must find something to fill their columns, and so print 
all the new plans of treatment and new remedies they 
can get hold of, as the newspapers, from a similar 
necessity, print the shocking catastrophes and terrible 
murders. 

Besides all this, here are we, the great body of teach- 
ers in the numberless medical schools of the Union, 
some of us lecturing to crowds who clap and stamp in 
the cities, some of us wandering over the country, like 
other professional fertilizers, to fecundate the minds of 
less demonstrative audiences at various scientific sta- 
tions ; all of us talking habitually to those supposed 
to know less than ourselves, and loving to claim as 
much for our art as we can, not to say for our own 
schools, and possibly indirectly for our own practical 
skill. Hence that annual crop of introductory lectures ; 
the useful blossoming into the ornamental, as the cab- 
bage becomes glorified in the cauliflower • that lecture- 
room literature of adjectives, that declamatory exag- 
geration, that splendid show of erudition borrowed from 
D'Israeli, and credited to Lord Bacon and the rest, 
which have suggested to our friends of the Medical 
Journals an occasional epigram at our expense. Hence 
the tendency in these productions, and in medical lec- 
tures generally, to overstate the efficacy of favorite 
methods of cure, and hence the premium offered for 
showy talkers rather than sagacious observers, for the 
men of adjectives rather than of nouns substantive in 
the more ambitious of these institutions. 

a " Ingeniorum Graeciae flatu impellimor. Palamquc est, ut 
quisque inter istos loquendo polleat, imperatorem illico vitae 
nostra? necisque fieri." — Piin. Hist. Mundi, xxix. 1. I hope I 
may use the old Roman liberty of speech without offence. 



CURRENTS AND COUNTER-CURRENTS. 195 

Sucli are some of the eddies in which we are liable 
to become involved and carried back ont of the broad 
stream of philosophical, or, in other words, truth-lov- 
ing, investigations. The causes of disease, in the 
mean time, have been less earnestly studied in the 
eagerness of the search for remedies. Speak softly ! 
Women have been borne out from an old-world hospi- 
tal, two in one coffin, that the horrors of their prison- 
house might not be known, while the very men who 
were discussing the treatment of the disease were stu- 
pidly conveying the infection from bed to bed, as rat- 
killers carry their poisons from one household to an- 
other. Do not some of you remember that I have had 
to fight this private-pestilence question against a scep- 
ticism which sneered in the face of a mass of evidence 
such as the calm statisticians of the Insurance office 
could not listen to without horror and indignation?** 
Have we forgotten what is told in one of the books 
published under our own sanction, that a simple meas- 
ure of ventilation, proposed by Dr. John Clark, had 
saved more than sixteen thousand children's lives in a 
single hospital ? 6 How long would it have taken small 
doses of calomel and rhubarb to save as many chil- 
dren? These may be useful in prudent hands, but 
how insignificant compared to the great hygienic con- 
ditions ! Causes, causes, and again causes, — more 
and more we fall back on these as the chief objects of 
our attention. The shortest system of medical prac- 
tice that I know of is the oldest, but not the worst. It 
is older than Hippocrates, older than Chiron the Cen- 

a " The Contagiousness of Puerperal Fever." — N. E. Quar. 
Jour, of Medicine and Surgery, April, 1843. Reprinted, with 
Additions. Boston: Ticknor & Fields. 1855. 

* Collins's Midwifery, p. 312. (In Lib. ofPrac. Med.) 



196 MEDICAL ESSAYS. 

taur. Nature taught it to the first mother when she 
saw her first-born child putting some ugly pebble or 
lurid berry into its mouth. I know not in what lan- 
guage it was spoken, but I know that in English it 
would sound thus : Spit it out ! 

Art can do something more than say this. It can 
sometimes reach the pebble or berry after it has been 
swallowed. But the great thing is to keep these things 
out of children's mouths, and as soon as they are be- 
yond our reach, to be reasonable and patient with Na- 
ture, who means well, but does not like to hurry, and 
who took nine calendar months, more or less, to every 
mother's son among us, before she thought he was fit 
to be shown to the public. 

Suffer me now to lay down a few propositions, 
whether old or new it matters little, not for your im- 
mediate acceptance, nor yet for your hasty rejection, 
but for your calm consideration. 

But first, there are a number of terms which we are 
in the habit of using in a vague though not unintelligi- 
ble way, and which it is as well now to define. These 
terms are the tools with which we are to work, and the 
first thing is to sharpen them. It is nothing to us that 
they have been sharpened a thousand times before ; 
they always get dull in the using, and every new work- 
man has a right to carry them to the grindstone and 
sharpen them to suit himself. 

Nature, in medical language, as opposed to Art, 
means trust in the reactions of the living system 
against ordinary normal impressions. 

Art, in the same language, as opposed to Nature, 
means an intentional resort to extraordinary abnormal 
impressions for the relief of disease. 

The reaction of the living system is the essence of 



CURRENTS AND COUNTER-CURRENTS. 197 

both. Food is nothing, if there is no digestive act to 
respond to it. We cannot raise a blister on a dead 
man, or hope that a carminative forced between his 
lips will produce its ordinary happy effect. 

Disease, dis-ease, — disturbed quiet, uncomfortable- 
ness, — means imperfect or abnormal reaction of the 
living system, and its more or less permanent results. 

Food, in its largest sense, is whatever helps to build 
up the normal structures, or to maintain their natural 
actions. 

Medicine, in distinction from food, is every unnatu- 
ral or noxious agent applied for the relief of disease. 

Physic means properly the Natural art, and Physi- 
cian is only the Greek synonyme of Naturalist. 

With these few explanations I proceed to unfold the 
propositions I have mentioned. 

Disease and death, if we may judge by the records 
of creation, are inherently and essentially necessary in 
the present order of things. A perfect intelligence, 
trained by a perfect education, could do no more than 
keep the laws of the physical and spiritual universe. 
An imperfect intelligence, imperfectly taught, — and 
this is the condition of our finite humanity, — will cer- 
tainly fail to keep all these laws perfectly. Disease is 
one of the penalties of one of the forms of such failure. 
It is prefigured in the perturbations of the planets, in 
the disintegration of the elemental masses ; it has left 
its traces in the fossil organisms of extinct creations.* 

° Professor Agassiz has kindly handed me the following note: 
" There arc abnormal structures in animals of all ages anterior 
to the creation of mankind. Malformed specimens of Crinoids 
are known from the Triassic and Jurassic deposits. Malformed 
and diseased bones of tertiary mammalia have been collected ia 
the caverns of Gailenreuth with traces of healing." 



198 MEDICAL ESSAYS. 

But it is especially the prerogative, I had almost said 
privilege, of educated and domesticated beings, from 
man down to the potato, serving to teach them, and 
such as train them, the laws of life, and to get rid of 
those who will not mind or cannot be kept subject to 
these laws. 

Disease, being always an effect, is always in exact 
proportion to the sum of its causes, as much in the case 
of Spigelius, who dies of a scratch, as in that of the man 
who recovers after an iron bar has been shot through 
his brain. The one prevalent failing of the medical 
art is to neglect the causes and quarrel with the effect. 
There are certain general facts which include a good 
deal of what is called and treated as disease. Thus, 
there are two opposite movements of life to be seen in 
cities and elsewhere, belonging to races which, from 
various persistent causes, are breeding down and tend- 
ing to run out, and to races which are breeding up, or 
accumulating vital capital, — a descending and an as- 
cending series. Let me give an example of each ; and 
that I may incidentally remove a common inpression 
about this country as compared with the Old World, 
an impression which got tipsy with conceit and stag- 
gered into the attitude of a formal proposition in the 
work of Dr. Robert Knox, a I will illustrate the down- 
Professor Jeffries Wyman hns also favored me with an inter- 
esting communication, from which I extract this statement: — 

"Necrosis, caries, anchylosis, and osteophytes have been ob- 
served in fossil bones. Zeis (Leipsie, 185G) has written a me- 
moir on the specimens of this nature contained in the Iloyal 
Cabinet of Natural History at Dresden." 

° " Already the Anglo-Saxon rears with difficulty his offspring 
in Australia: it is the same in most parts of America. But for 
the supplies they receive from Europe the race would perish, 
even in these most healthy climates." — The Races of Mer^ 
Philadelphia, 1850, p. 317. 



CURRENTS AND COUNTER-CURRENTS. 199 

ward movement from English experience, and the up- 
ward movement from a family history belonging to this 
immediate neighborhood. 

Miss Nightingale speaks of " the fact so often seen 
of a great-grandmother, who was a tower of physical 
vigor, descending into a grandmother perhaps a little 
less vigorous, but still sound as a bell, and healthy to 
the core, into a mother languid and confined to her 
carriage and house, and lastly into a daughter sickly 
and confined to her bed." So much for the descend- 
ing English series ; now for the ascending American 
series. 

Something more than one hundred and thirty years 
ago there graduated at Harvard College a delicate 
youth, who lived an invalid life and died at the age of 
about fifty. His two children were both of moderate 
physical power, and one of them diminutive in stature. 
The next generation rose in physical development, and 
reached eighty years of age and more in some of its 
members. The fourth generation was of fair average 
endowment. The fifth generation, great-great-grand- 
children of the slender invalid, are several of them of 
extraordinary bodily and mental power ; large in stat- 
ure, formidable alike with their brains and their arms, 
organized on a more extensive scale than either of 
their parents. 

This brief account illustrates incidentally the fallacy 
of the universal-degeneration theory applied to Ameri- 
can life ; the same on which one of our countrymen 
has lately brought some very forcible facts to bear in a 
muscular discussion of which we have heard rather 
more than is good for us. But the two series, Ameri- 
can and English, ascending and descending, were ad- 
duced with the main purpose of showing the immense 



200 MEDICAL ESSAYS. 

difference of vital endowments in different strains of 
blood ; a difference to which all ordinary medication 
is in all probability a matter of comparatively trivial 
purport. Many affections which art has to strive 
against might be easily shown to be vital to the well- 
being of society. Hydrocephalus, tabes mesenterica, 
and other similar maladies, are natural agencies which 
cut off the children of races that are sinking below the 
decent minimum which nature has established as the 
condition of viability, before they reach the age of re- 
production. They are really not so much diseases, as 
manifestations of congenital incapacity for life ; the 
race would be ruined if art coidd ever learn always to 
preserve the individuals subject to them. AVe must do 
the best we can for them, but we ought also to know 
what these " diseases " mean. 

Again, invalidism is the normal state of many or- 
ganizations. It can be changed to disease, but never 
to absolute health by medicinal appliances. There are 
many ladies, ancient and recent, who arc perpetually 
taking remedies for irremediable pains and aches. 
They ougltt to have headaches and back-aches and 
stomach-aches; they are not well if they do not have 
them. To expect them to live without frequent twinges 
is like expecting a doctor's old chaise to go without 
creaking; if it did, we might be sure the springs were 
broken. There is no doubt that the constant demand 
for medicinal remedies from patients of this class leads 
to their over-use ; often in the case of cathartics, some- 
times in that of opiates. I have been told by an intel- 
ligent practitioner in a Western town, that the constant 
prescription of opiates by certain physicians in his vi- 
cinity has rendered the habitual use of that drug in all 
that region very prevalent ; more common, I should 



CURRENTS AND COUNTER-CURRENTS. 201 

think, than alcoholic drunkenness in the most intem- 
perate localities of which I have known anything. A 
frightful endemic demoralization betrays itself in the 
frequency with which the haggard features and droop- 
ing shoulders of the opium-drunkards are met with in 
the streets. 

The next proposition I would ask you to consider is 
this : — 

The presiimjition always is that every noxious agent, 
including medicines proper, which hurts a well man, 
hurts a sick one. [Note B.~\ 

Let mc illustrate this proposition before you decide 
upon it. If it were known that a prize-fighter were 
to have a drastic purgative administered two or three 
days before a contest, or a large blister applied to his 
back, no one will question that it would affect the bet- 
ting on his side unfavorably ; we will say to the 
amount of five per cent. Now the drain upon the re- 
sources of the system produced in such a case must 
be at its minimum, for the subject is a powerful man, 
in the prime of life, and in admirable condition. If 
the drug or the blister takes five per cent, from his 
force of resistance, it will take at least as large a frac- 
tion from any invalid. But this invalid has to fight a 
champion who strikes hard but cannot be hit in return, 
who will press him sharply for breath, but will never 
pant himself while the wind can whistle through his 
fleshless ribs. The suffering combatant is liable to 
want all his stamina, and five per cent, may lose him 
the battle. 

All noxious agents, all appliances which are not nat- 
ural food or stimuli, all medicines proper, cost a pa- 
tient, on the average, five per cent, of his vital force, 
let us say. Twenty times as much waste of force pro- 



202 MEDICAL ESSAYS. 

duced by any of them, that is, would exactly kill hi:n, 
nothing less than kill him, and nothing more. If this, 
or something like this, is true, then all these medica- 
tions are, prima facie, injurious. 

In the game of Life-or-Death, Ronge et Noir, as 
played between the Doctor and the Sexton, this five 
per cent., this certain small injury entering into the 
chances is clearly the sexton's perquisite for keeping 
the green table, over which the game is played, and 
where he hoards up his gains. Suppose a blister to 
diminish a man's pain, effusion or dyspnoea to the sav- 
ing of twenty per cent, in vital force ; his profit from 
it is fifteen, in that case, for it always hurts him five 
to begin with, according to our previous assumption. 

Presumptions are of vast importance in medicine, 
as in law. A man is presumed innocent until he is 
proved guilty. A medicine — that is, a noxious agent, 
like a blister, a seton, an emetic, or a cathartic — should 
always be presumed to be hurtful. It always is di- 
rectly hurtful; it may sometimes be indirectly ben- 
eficial. If this presumption were established, and 
disease always assumed to be the innocent victim of 
circumstances, and not punishable by medicines, that 
is, noxious agents, or poisons, until the contrary was 
shown, we should not so frequently hear the remark 
commonly, perhaps erroneously, attributed to Sir Ast- 
ley Cooper, but often repeated by sensible persons, 
that, on the whole, more harm than good is done by 
medication. Throw out opium, which the Creator 
himself seems to prescribe, for we often see the scarlet 
poppy growing in the cornfields, as if it were foreseen 
that wherever there is hunger to be fed there must 
also be pain to be soothed ; throw out a few specifics 
which our art did not discover, and is hardly needed 



CURRENTS AND COUNTER-CURRENTS. 203 

to apply \_JVote C] ; throw out wine, which is a food, 
and the vapors which produce the miracle of anaesthe- 
sia, and I firmly believe that if the whole materia 
medica, as now used, could be sunk to the bottom of 
the sea, it would be all the better for mankind, — and 
all the worse for the fishes. 

But to justify this proposition, I must add that the 
injuries inflicted by over-medication are to a great ex- 
tent masked by disease. Dr. Hooker believes that the 
typhus syncopalis of a preceding generation in New 
England " was often in fact a brandy and opium dis- 
ease." How is a physician to distinguish the irritation 
produced by his blister from that caused by the inflam- 
mation it was meant to cure ? How can he tell the 
exhaustion produced by his evacuants from the col- 
lapse belonging to the disease they were meant to re- 
move ? 

Lastly, medication without insuring favorable hygi- 
enic conditions is like amputation without ligatures. 
I had a chance to learn this well of old, when physi- 
cian to the Broad Street district of the Boston Dispen- 
sary. There, there was no help for the utter want of 
wholesome conditions, and if anybody got well under 
my care, it must have been in virtue of the rough-and- 
tumble constitution which emerges from the struggle 
for life in the street gutters, rather than by the aid of 
my prescriptions. 

But if the materia medica were lost overboard, how 
much more pains would be taken in ordering all the 
circumstances surrounding the patient (as can be done 
everywhere out of the crowded pauper districts), than 
are taken now by too many who think they do their 
duty and earn their money when they write a recipe 
for a patient left in an atmosphere of domestic malaria, 



204 MEDICAL ESSAYS. 

or to the most negligent kind of nursing ! I confess 
that I should think my chance of recovery from illness 
less with Hippocrates for my physician and Mrs. Gamp 
for my nurse, than if I were in the hands of Hahne- 
mann himself, with Florence Nightingale or good Re- 
becca Taylor to care for me. 

If I am right in maintaining that the presunvption 
is always against the use of noxious agents in disease, 
and if any whom I might influence should adopt this 
as a principle of practice, they will often find them- 
selves embarrassed by the imperative demand of pa- 
tients and their friends for such agents where a case is 
not made out against this standing presumption. I 
must be permitted to say, that I think the French, a 
not wholly uncivilized people, are in advance of the 
English and ourselves in the art of prescribing for the 
sick without hurting them. And I do confess that I 
think their varied ptisans and syrups are as much pref- 
erable to the mineral regimen of bug-poison and rats- 
bane, so long in favor on the other side of the Chan- 
nel, as their art of preparing food for the table to the 
rude cookery of those hard-feeding and much-dosing 
islanders. We want a reorganized cuisine of invalid- 
ism perhaps as much as the culinary reform, for which 
our lyceum lecturers, and others who live much at 
hotels and taverns, are so urgent. Will you think 1 
am disrespectful if I ask whether, even in Massachu- 
setts, a dose of calomel is not sometimes given by a 
physician on the same principle as that upon which a 
landlord occasionally prescribes bacon and eggs, — be- 
cause he cannot think of anything else quite so handy ? 
I leave my suggestion of borrowing a hint from French 
practice to your mature consideration. 

I may, however, call your attention, briefly, to the 



CUREENTS AND COUNTER-CURRENTS. 205 

singular fact, that English and American practitioners 
are apt to accuse French medical practice of inertness, 
and French surgical practice of unnecessary activity. 
Thus, Dr. Bostock considers French medical treatment, 
with certain exceptions, as " decidedly less effective " 
than that of his own country. Mr. S. Cooper, again, 
defends the simple British practice of procuring union 
by the first intention against the attacks of M. Roux 
and Baron Larrey. 6 We have often heard similar 
opinions maintained by our own countrymen. While 
Anglo-American criticism blows hot or cold on the two 
departments of French practice, it is not, I hope, in- 
decent to question whether all the wisdom is necessarily 
with us in both cases. 

Our art has had two or three lessons which have a 
deep meaning to those who are willing to read them 
honestly. The use of water-dressings in surgery com- 
pleted the series of reforms by which was abolished 
the " coarse and cruel practice " of the older surgeons, 
who with their dressings and acrid balsams, their tents 
and leaden tubes, " absolutely delayed the cure." The 
doctrine of Broussais, transient as was its empire, re- 
versed the practice of half of Christendom for a sea- 
son, and taught its hasty disciples to shun their old 
favorite remedies as mortal poisons. This was not 
enough permanently to shift the presumption about 

° Hist, of Med., in Cyc. ofPrac. Med. vol. i. p. 70. 

b Cooper's Surg. Diet. art. " Wounds." Yet Mr. John Bell gives 
tin 1 French surgeons credit for introducing this doctrine of ad- 
hesion, and accuses O'Halloran of " rudeness and ignorance," 
and "bold, uncivil language," in disputing their teaching. — 
Priuc. of Surgery, vol. i. p. 42. Mr. Hunter succeeded at last 
in naturalizing the doctrine and practice, but even he had to 
struggle against the perpetual jealousy of rivals, and died at 
length assassinated by an insult. 



206 MEDICAL ESSAYS. 

drugs where it belonged, and so at last, just as the 
sympathetic powder and the Unguentum Armarium 
came in a superstitious age to kill out the abuses of 
external over-medication, the solemn farce of Homoeop- 
athy was enacted in the face of our own too credulous 
civilization, that under shelter of its pretences the 
" inward bruises " of over-drugged viscera might be 
allowed to heal by the first intention. Its lesson we 
must accept, whether we will or not ; its follies we are 
tired of talking about. The security of the medical 
profession against this and all similar fancies is in the 
average constitution of the human mind with regard 
to the laws of evidence. 

My friends and brothers in Art ! There is nothing 
to be feared from the utterance of any seeming heresy 
to which you may have listened. I cannot compromise 
your collective wisdom. If I have strained the truth 
one hair's breadth for the sake of an epigram or an 
antithesis, you are accustomed to count the normal 
pulse-beats of sound judgment, and know full well how 
to recognize the fever-throbs of conceit and the ner- 
vous palpitations of rhetoric. 

The freedom with which each of us speaks his 
thought in this presence, belongs in part to the assured 
position of the Profession in our Commonwealth, to 
the attitude of Science, which is always fearless, and 
to the genius of the soil on which we stand, from which 
Nature withheld the fatal gift of malaria only to fill it 
with exhalations that breed the fever of inquiry in our 
blood and in our brain. But mainly we owe the large 
license of speech we enjoy to those influences and priv- 
ileges common to us all as self-governing Americans. 

This Republic is the chosen home of minorities, of 



CURRENTS AND COUNTER-CURRENTS. 207 

the less power in the presence of the greater. It is a 
common error to speak of our distinction as consisting 
in the rule of the majority. Majorities, the greater 
material powers, have always ruled before. The his- 
tory of most countries has been that of majorities, — 
mounted majorities, clad in iron, armed with death, 
treading down the tenfold more numerous minorities. 
In the old civilizations they root themselves like oaks 
in the soil ; men must live in their shadow or cut them 
down. With us the majority is only the flower of the 
passing noon, and the minority is the bud which may 
open in the next morning's sun. We must be tolerant, 
for the thought which stammers on a single tongue to- 
day may organize itself in the growing consciousness 
of the time, and come back to us like the voice of the 
multitudinous waves of the ocean on the morrow. 

Twenty-five years have passed since one of your 
honored Presidents spoke to this Society of certain 
limitations to the power of our Art, now very generally 
conceded. Some were troubled, some were almost 
angry, thinking the Profession might suffer from such 
concessions. It has certainly not suffered here ; if, as 
some affirm, it has lost respect anywhere, it was prob- 
ably for other, and no doubt sufficient reasons. 

Since that time the civilization of this planet has 
changed hands. Strike out of existence at this mo- 
ment every person who was breathing on that day, 
May 27, 1835, and every institution of society, every 
art and every science would remain intact and com- 
plete in the living that would be left. Every idea the 
world then held has been since dissolved and recrystal- 
lized. 

We are repeating the same process. Not to make 
silver shrines for our old divinities, even though by 



208 MEDICAL ESSAYS. 

this craft we should have our wealth, was this Society 
organized and carried on by the good men and true 
who went before us. Not for this, but to melt the gold 
out of the past, though its dross should fly in dust to 
all the winds of heaven, to save all our old treasures of 
knowledge and mine deeply for new, to cultivate that 
mutual respect of which outward courtesy is the sign, 
to work together, to feel together, to take counsel to- 
gether, and to stand together for the truth, now, al- 
ways, here, everywhere ; for this our fathers instituted, 
and we accept, the offices and duties of this time-hon- 
ored Society. 



IV. 

BORDER LINES OF KNOWLEDGE IN SOME PROV- 
INCES OF MEDICAL SCIENCE." 

[This Lecture appears as it would have been delivered had the time al- 
lowed been less strictly limited. Passages necessarily omitted have been 
restored, and points briefly touched have been more fully considered. A 
few notes have been added for the benefit of that limited class of students 
who care to track an author through the highways and by-ways of his 
reading. I owe my thanks to several of my professional brethren who 
have communicated with me on subjects with which they are familiar; es- 
pecially to Dr. John Dean, for the opportunity of profiting by his unpub- 
lished labors, and to Dr. Hasket Derby, for information and references to 
recent authorities relating to the anatomy and physiology of the eye.] 

The entrance upon a new course of Lectures is al- 
ways a period of interest to instructors and pupils. As 
the birth of a child to a parent, so is the advent of a 
new class to a teacher. As the light of the untried 
world to the infant, so is the dawning of the light rest- 
ing over the unexplored realms of science to the stu- 
dent. In the name of the Faculty I welcome you, 
Gentlemen of the Medical Class, new-born babes of 
science, or lustier nurslings, to this morning of your 
medical life, and to the arms and the bosom of this an- 
cient University. Fourteen years ago I stood in this 
place for the first time to address those who occupied 
these benches. As I recall these past seasons of our 
joint labors, I feel that they have been on the whole 
prosperous, and not undeserving of their prosperity. 

a An Introductory Lecture delivered before the Medical Class 
of Harvard University, November 6, 1861. 
1* 



210 MEDICAL ESSAYS. 

For it lias been my privilege to be associated with a 
body of true and faithful workers ; I cannot praise 
them freely to their faces, or I should be proud to dis- 
course of the harmonious diligence and the noble spirit 
in which they have toiled together, not merely to teach 
their several branches, but to elevate the whole stand- 
ard of teaching. 

I may speak with less restraint of those gentlemen 
who have aided me in the most laborious part of my 
daily duties, the Demonstrators, to whom the succes- 
sive classes have owed so much of their instruction. 
They rise before me, the dead and the living, in the 
midst of the most grateful recollections. The fair, 
manly face and stately figure of my friend, Dr. Sam- 
uel Parkman, himself fit for the highest offices of 
teaching, yet willing to be my faithful assistant in the 
time of need, come back to me with the long sigh of 
regret for his early loss to our earthly companionship. 
Every year I speak the eulogy of Dr. Ainsworth's pa- 
tient toil as I show his elaborate preparations. When 
I take down my " American Cyclopaedia " and borrow 
instruction from the learned articles of Dr. Kneeland, 
I cease to regret that his indefatigable and intelligent 
industry was turned into a broader channel. And what 
can I say too cordial of my long associated companion 
and friend, Dr. I lodges, whose admirable skill, work- 
ing through the swiftest and surest fingers that ever 
held a scalpel among us, has delighted class after class, 
and filled our Museum with monuments which will 
convey his name to unborn generations ? 

This day belongs, however, not to myself and my 
recollections, but to all of us who teach and all of you 
who listen, whether experts in our specialties or aliens 
to their mysteries, or timid neophytes just entering the 



BORDER LINES IN MEDICAL SCIENCE. 211 

portals of the hall of science. Look in with me, then, 
while I attempt to throw some rays into its interior, 
which shall illuminate a few of its pillars and cornices, 
and show at the same time how many niches and al- 
coves remain in darkness. 

Science is the topography of ignorance. From a 
few elevated points we triangulate vast spaces, inclos- 
ing infinite unknown details. We cast the lead, and 
draw up a little sand from abysses we may never reach 
with our dredges. 

The best part of our knowledge is that which teaches 
us where knowledge leaves off and ignorance begins. 
Nothing more clearly separates a vulgar from a su- 
perior mind, than the confusion in the first between 
the little that it truly knows, on the one hand, and 
what it half knows and what it thinks it knows on the 
other. 

That which is true of every subject is especially true 
of the branch of knowledge which deals with living 
beings. Their existence is a perpetual death and re- 
animation. Their identity is only an idea, for we put 
off our bodies many times during our lives, and dr*ess 
in new suits of bones and muscles. 

" Thou art not thyself ; 
For thou exist'st on many a thousand grains 
That issue out of dust." a 

If it is true that we understand ourselves but imper- 
fectly in health, this truth is more signally manifested 
in disease, where natural actions imperfectly under- 
stood, disturbed in an obscure way by half-seen causes, 

° " Occasio enim prseceps est propter artis materiam, dico 
autem corpus, quod continue flint et inomento temporis trans- 
mutatur." — Galen, Com. in Aphorism. Hippoc. i. 1. 



212 MEDICAL ESSAYS. 

are creeping and winding along in the dark toward 
their destined issue, sometimes using our remedies as 
safe stepping-stones, occasionally, it may be, stumbling 
over them as obstacles. 

I propose in this lecture to show you some points of 
contact between our ignorance and our knowledge in 
several of the branches upon the study of which you 
are entering. I may teach you a very little directly, 
but I hope much more from the trains of thought I 
shall suggest. Do not expect too much ground to be 
covered in this rapid survey. Our task is only that of 
sending out a few pickets under the starry flag of 
science to the edge of that dark domain where the en- 
signs of the obstinate rebel, Ignorance, are flying un- 
disputed. We are not making a reconnoissance in 
force, still less advancing with the main column. But 
here are a few roads along which we have to march 
together, and we wish to see clearly how far our lines 
extend, and where the enemy's outposts begin. 

Before touching the branches of knowledge that 
deal with organization and vital functions, let us glance 
at that science which meets you at the threshold of 
your study, and prepares you in some measure to deal 
with the more complex problems of the living labora- 
tory. 

Chemistry includes the art of separating and com- 
bining the elements of matter, and the study of the 
changes produced by these operations. We can hardly 
say too much of what it has contributed to our knowl- 
edge of the universe and our power of dealing with its 
materials. It has given us a catalogue raisonne of 
the substances found upon our planet, and shown how 



BORDER LINES IN MEDICAL SCIENCE. 213 

everything living and dead is put together from them. 
It is accomplishing wonders before us every day, such 
as Arabian story-tellers used to string together in their 
fables. It spreads the sensitive film on the artificial 
retina which looks upon us through the optician's lens 
for a few seconds, and fixes an image that will outlive 
its original. It questions the light of the sun, and de- 
tects the vaporized metals floating around the great 
luminary, — iron, sodium, lithium, and the rest, — as 
if the chemist of our remote planet could fill his bell- 
glasses from its fiery atmosphere." It lends the power 
which flashes our messages in thrills that leave the lazy 
chariot of day behind them. It seals up a few dark 
grains in iron vases, and lo ! at the touch of a single 
spark, rises in smoke and flame a mighty Afrit with a 
voice like thunder and an arm that shatters like an 
earthquake. The dreams of Oriental fancy have be- 
come the sober facts of our every-day life, and the 
chemist is the magician to whom we owe them. 

To return to the colder scientific aspect of chemis- 
try. It has shown us how bodies stand affected to 
each other through an almost boundless range of com- 
binations. It has given us a most ingenious theory to 
account for certain fixed relations in these combina- 
tions. It has successfully eliminated a great number 
of proximate compounds, more or less stable, from or- 
ganic structures. It has invented others which form 
the basis of long series of well-known composite sub- 
stances. In fact, we are perhaps becoming overbur- 
dened with our list of proximate principles, demon- 
strated and hypothetical. 

How much nearer have we come to the secret of 

" Scientific. Annual for 1861. — Fairbairn's Address before the 
British Association, 1861. 



214 MEDICAL ESSAYS. 

force than Lully and Geber and the whole crew of 
juggling alchemists ? We have learned a great deal 
about the how, what have we learned about the why ? 

Why does iron rust, while gold remains untarnished, 
and gold amalgamate, while iron refuses the alliance 
of mercury ? 

The alchemists called gold Sol, the sun, and iron 
Mars, and pleased themselves with fancied relations 
between these substances and the heavenly bodies, by 
which they pretended to explain the facts they ob- 
served. Some of their superstitions have lingered in 
practical medicine to the present day, but chemistry 
has grown wise enough to confess the fact of absolute 
ignorance. 

What is it that makes common salt crystallize in the 
form of cubes, and saltpetre in the shape of six-sided 
prisms? We see no reason why it should not have 
been just the other way, salt in prisms and saltpetre 
in cubes, or why either should take an exact geometri- 
cal outline, any more than coagulating albumen. 

But although we had given up attempting to explain 
the essential nature of affinities and of crystalline 
types, we might have supposed that we had at least 
fixed the identity of the substances with which we deal, 
and determined the laws of their combination. All at 
once we find that a simple Bubstance changes face, puts 
off its characteristic qualities and resumes them at will ; 
— not merely when we liquefy or vaporize a solid, or 
reverse the process ; but that a solid is literally trans- 
formed into another solid under our own eyes. We 
thought we knew phosphorus. We warm a portion of 
it sealed in an empty tube, for about a week. It has 
become a brown infusible substance, which does not 
shine in the dark nor oxidate in the air. We heat it 



BORDER LINES IN MEDICAL SCIENCE. 215 

to 500° F., and it becomes common phosphorus again. 
We transmute sulphur in the same singular way. Na- 
ture, you know, gives us carbon in the shape of coal 
and in that of the diamond. It is easy to call these 
changes by the name allotrojrism, but not the less do 
they confound our hasty generalizations. 

These facts of allotropism have some corollaries con- 
nected with them rather startling to us of the nine- 
teenth century. There may be other transmutations 
possible besides those of phosphorus and sulphur. 
When Dr. Prout, in 1840, talked about azote and car- 
bon being " formed " in the living system, it was looked 
upon as one of those freaks of fancy to which philos- 
ophers, like other men, are subject. But when Profes- 
sor Faraday, in 1851, says, at a meeting of the British 
Association, that " his hopes are in the direction of 
proving that bodies called simple were really com- 
pounds, and may be formed artificially as soon as we 
are masters of the laws influencing their combinations," 
— when he comes forward and says that he has tried 
experiments at transmutation, and means, if his life is 
spared, to try them again, — how can we be surprised 
at the popular story of 1861, that Louis Napoleon has 
established a gold-factory and is glutting the mints of 
Europe with bullion of his own making ? 

And so with reference to the law of combinations. 
The old maxim was, Corpora non agunt nisi soluta. 
If two substances, a and 6, are inclosed in a glass ves- 
sel, c, we do not expect the glass to change them, unless 
a or b or the compound a b has the power of dissolving 
the glass. But if for a I take oxygen, for b hydrogen, 
and for c a piece of spongy platinum, I find the first 
two combine with the common signs of combustion and 
form water, the third in the mean time undergoing no 



216 MEDICAL ESSAYS. 

perceptible change. It lias played the part of the un- 
wedded priest, who marries a pair without taking* a 
fee or having any further relation with the parties. 
We call this catalysis, catalytic action, the action of 
presence, or by what learned name we choose. Give 
what name to it we will, it is a manifestation of power 
which crosses our established laws of combination at a 
very open angle of intersection. I think we may find 
an analogy for it in electrical induction, the disturbance 
of the equilibrium of the electricity of a body by the 
approach of a charged body to it, without interchange 
of electrical conditions between the two bodies. But 
an analogy is not an explanation, and why a few drops 
of yeast should change a saccharine mixture to carbonic 
acid and alcohol, — a little leaven leavening the whole 
lump, — not by combining with it, but by setting a 
movement at work, we not only cannot explain, but the 
fact is such an exception to the recognized laws of com- 
bination that Liebig is unwilling to admit the new 
force at all to which Berzelius had given the name so 
generally accepted. 

The phenomena of isomerism, or identity of com- 
position and proportions of constituents with difference 
of qualities, and of isomorphism, or identity of form in 
crystals which have one clement substituted for another, 
were equally surprises to science ; and although the 
mechanism by which they are brought about can be to 
a certain extent explained by a reference to the hypo- 
thetical atoms of which the elements are constituted, 
yet this is only turning the difficulty into a fraction 
with an infinitesimal denominator and an infinite nu- 
merator. 

So far we have studied the working of force and its 
seeming anomalies in purely chemical phenomena. 



BORDER LINES IN MEDICAL SCIENCE. 217 

But we soon find that chemical force is developed by 
various other physical agencies, — by heat, by light, by 
electricity, by magnetism, by mechanical agencies ; 
and, vice versa, that chemical action develops heat, 
light, electricity, magnetism, mechanical force, as we 
see in our matches, galvanic batteries, and explosive 
compounds. Proceeding with our experiments, we find 
that every land of force is capable of producing all 
other kinds, or, in Mr. Faraday's language, that " the 
various forms under which the forces of matter are 
made manifest have a common origin, or, in other 
words, are so directly related and mutually dependent 
that they are convertible one into another." 

Out of this doctrine naturally springs that of the 
conservation of force, so ably illustrated by Mr. Grove, 
Dr. Carpenter, and Mr. Faraday. This idea is no 
novelty, though it seems so at first sight. It was main- 
tained and disputed among the giants of philosophy. 
Des Cartes and Leibnitz denied that any new motion 
originated in nature, or that any ever ceased to exist ; 
all motion being in a circle, passing from one body to 
another, one losing what the other gained. Newton, 
on the other hand, believed that new motions were gen- 
erated and existing ones destroyed. On the first sup- 
position, there is a fixed amount of force always 
circulating in the universe. On the second, the total 
amount may be increasing or diminishing. You will 
find in the " Annual of Scientific Discovery " for 1858 
a very interesting lecture by Professor Helmholtz of 
Bonn, in which it is maintained that a certain por- 
tion of force is lost in every natural process, being 
converted into unchangeable heat, so that the universe 
will come to a stand-still at last, all force passing into 
heat, and all heat into a state of equilibrium. 



218 MEDICAL ESSAYS. 

The doctrines of the convertibility or specific equiv- 
alence of the various forms of force, and of its con- 
servation, which is its logical consequence, are very 
generally accepted, as I believe, at the present time, 
among physicists. We are naturally led to the ques- 
tion, What is the nature of force ? The three illustri- 
ous philosophers just referred to agree in attributing 
the general movements of the universe to the immedi- 
ate Divine action. a The doctrine of " preestablished 
harmony " was an especial contrivance of Leibnitz to 
remove the Creator from unworthy association with the 
less divine acts of living beings. Obsolete as this ex- 
pression sounds to our ears, the phrase laws of the 
universe^ which we use so constantly with a wider ap- 
plication, appears to me essentially identical with it. 

Force does not admit of explanation, nor of proper 
definition, any more than the hypothetical substratum 
of matter. If we assume the Infinite as omnipresent, 
omniscient, omnipotent, we cannot suppose Him ex- 
cluded from any part of His creation, except from 
rebellious souls which voluntarily exclude Him by the 

° *' Et generalcm quod attinet, manifest um mihi videtur illam 
[eausam] non aliam esse, quam Deum ipsum, qui niateriam 
simul cum niotu et quiete in principio ereavit, jamque per solum 
suum eoneursum ordinarium, tantundem motus et quietia in ea 
iota quantum tune posuit conservat: . . . . eodem plane modo, 
eademque ratione qua prius ereavit, eum etiam tantundem 
motus in ipsa semper eonservare." — Des Cartes, Princ. Phil. 
pt. ii. § xxx vi. 

" Concursus Dei, actioni creaturae necessarius." — Leibnitz, 
Op. torn. vi. p. 1 74. 

" In ipso continentur et moventur universa, sed absque mutua 
passione. Dens nihil patitur ex corporum motibuS: ilia nullum 
sentiunt resistentiam ex ornnipnesentia Dei." — Newton, Prin* 
cipia, lib. iii. Sehol. Gen. 



BORDER LINES IN MEDICAL SCIENCE. 219 

exercise of their fatal prerogative of f ree-will. a Force, 
then, is the act of immanent Divinity. I find no mean- 
ing in mechanical explanations. Newton's hypothesis 
of an ether filling the heavenly spaces does not, I con- 
fess, help my conceptions. I will, and the muscles of 
my vocal organs shape my speech. God wills, and the 
universe articulates His power, wisdom, and goodness. 
That is all I know. There is no bridge my mind can 
throw from the " immaterial " cause to the " material " 
effect. 

The problem of force meets us everywhere, and I 
prefer to encounter it in the world of physical phenom- 
ena before reaching that of living actions. It is only 
the name for the incomprehensible cause of certain 
changes known to our consciousness, and assumed to 
be outside of it. For me it is the Deity Himself in ac- 
tion. 

I can therefore see a large significance in the some- 
what bold language of Burdach : " There is for me but 
one miracle, that of infinite existence, and but one 
mystery, the manner in which the finite proceeds from 
the infinite. So soon as we recognize this incomprehen- 
sible act as the general and primordial miracle, of 
which our reason perceives the necessity, but the man- 
ner of which our intelligence cannot grasp, so soon as 
we contemplate the nature known to us by experience 

° " Cum unaquaeque spatii particula sit semper, et unumquodque 
dnraticmis indivisibile momentum ubique ; certe rerum omnium 
Fabricator ac Dominus non erit nunquam nusquam. Omniprae- 
sens est non per virtutem sol am, sed etiam per substcmtlam, ; nam 
virtus sine substantia subsistere non potest." — Newton, loc. cit. 

" The Lord of all, himself through all diffused, 
Sustains and is the life of all that lives." 

The Task, bk. vi. 1. 221, 222. 



220 MEDICAL ESSAYS. 

in this light, there is for us no other impenetrable 
miracle or mystery." a 

Let us turn to a branch of knowledge which deals 
with certainties up to the limit of the senses, and is 
involved in no speculations beyond them. In certain 
points of view, Human Anatomy may be considered 
an almost exhausted science. From time to time some 
small organ which had escaped earlier observers has 
been pointed out, — such parts as the tensor tarsi, the 
otic ganglion, or the Pacinian bodies ; but some of our 
best anatomical works are those which have been clas- 
sic for many generations. The plates of the bones in 
Vesalius, three centuries old, are still masterpieces of 
accuracy, as of art. The magnificent work of Albinus 
on the muscles, published in 1747, is still supreme in 
its department, as the constant references of the most 
thorough recent treatise on the subject, that of Theile, 
sufficiently show. More has been done in unravelling 
the mysteries of the fascia?, but there has been a ten- 
dency to overdo this kind of material analysis. Alex- 
ander Thomson split them up into cobwebs, as you may 
see in the plates to Velpeau's Surgical Anatomy. I 
well remember how he used to shake his head over the 
coarse work of Scarpa and Astley Cooper, — as if 
Denner, who painted the separate hairs of the beard 
and pores of the skin in his portraits, had spoken 
lightly of the pictures of Rubens and Vandyk. 

Not only has little been added to the catalogue of 
parts, but some things long known had become half- 
forgotten. Louis and others confounded the solitary 
glands of the lower part of the small intestine with 
those which " the great Brunner," as Haller calls him, 
* Physiolngie (Trad, de Jourdan), ii. 326. 



BORDER LINES IN MEDICAL SCIENCE. 221 

described in 1G87 as being found in the duodenum. 
The display of the fibrous structure of the brain 
seemed a novelty as shown by Spurzheim. One is 
startled to find the method anticipated by Raymond 
Vieussens nearly two centuries ago. I can hardly 
think Gordon had ever looked at his figures, though 
he names their author, when he wrote the captious and 
sneering article which attracted so much attention in 
the pages of the "Edinburgh Review." 6 * 

This is the place, if anywhere, to mention any obser- 
vations I could pretend to have made in the course of 
my teaching the structure of the human body. I can 
make no better show than most of my predecessors in 
this well-reaped field. The nucleated cells found con- 
nected with the cancellated structure of the bones, 
which I first pointed out and had figured in 1847, and 
have shown yearly from that time to the present, and 
the fossa masseterica, a shallow concavity on the ra- 
mus of the lower jaw, for the lodgment of the masseter 
muscle, which acquires significance when examined by 
the side of the deep cavity on the corresponding part 
in some carnivora to which it answers, may perhaps be 
claimed as deserving attention. I have also pleased 
myself by making a special group of the six radiating 
muscles b which diverge from the spine of the axis, or 
second cervical vertebra, and by giving to it the name 
stella musculosa nuchce. But this scanty catalogue is 
only an evidence that one may teach long and see little 
that has not been noted by those who have gone before 
him. Of course I do not think it necessary to include 
rare, but already described anomalies, such as the epi- 

a June, 1815. 

6 Rectus capitis posticus major, obliquus capitis inferior, and 
temispinalis colli, on each side. 



222 MEDICAL ESSAYS. 

sternal bones, the rectus sternalis, and other interesting 
exceptional formations I have encountered, which have 
shown a curious tendency to present themselves sev- 
eral times in the same season, perhaps because the 
first specimen found calls our attention to any we may 
subsequently meet with. 

The anatomy of the scalpel and the amphitheatre 
was, then, becoming an exhausted branch of investiga- 
tion. But during the present century the study of the 
human body has changed its old aspect, and become 
fertile in new observations. This rejuvenescence was 
effected by means of two principal agencies, — new 
methods and a new instrument. 

Descriptive anatomy, as known from an early date, 
is to the body what geography is to the planet. Now 
geography was pretty well known so long ago as when 
Arrowsmith, who was born in 1750, published his ad- 
mirable maps. But in that same year was born Wer- 
ner, who taught a new way of studying the earth, since 
become familiar to us all under the name of Geology. 

What geology has done for our knowledge of the 
earth, has been done for our knowledge of the body by 
that method of study to which is given the name of 
General Anatomy. It studies, not the organs as such, 
but the elements out of which the organs are con- 
structed. It is the geology of the body, as that is the 
general anatomy of the earth. The extraordinary 
genius of Bichat, to whom more than any other we 
owe this new method of study, does not require Mr. 
Buckle's testimony to impress the practitioner with the 
importance of its achievements. I have heard a very 
wise physician question whether any important result 
had accrued to practical medicine from Harvey's dis- 
covery of the circulation. But Anatomy, Physiology, 



BORDER LINES IN MEDICAL SCIENCE. 223 

and Pathology have received a new light from this 
novel method of contemplating the living structures, 
which has had a vast influence in enabling the practi- 
tioner at least to distinguish and predict the course of 
disease. We know as well what differences to expect 
in the habits of a mucous and of a serous membrane, 
as what mineral substances to look for in the chalk or 
the coal measures. You have only to read Cullen's 
description of inflammation of the lungs or of the 
bowels, and compare it with such as you may find in 
Laennec or Watson, to see the immense gain which 
diagnosis and prognosis have derived from general 
anatomy. 

The second new method of studying the human 
structure, beginning with the labors of Scarpa, Burns, 
and Colles, grew up principally during the first third 
of this century. It does not deal with organs, as did 
the earlier anatomists, nor with tissues, after the man- 
ner of Bichat. It maps the whole surface of the body 
into an arbitrary number of regions, and studies each 
region successively from the surface to the bone, or be- 
neath it. This hardly deserves the name of a science, 
although Velpeau has dignified it with that title, but 
it furnishes an admirable practical way for the surgeon 
who has to operate on a particular region of the body 
to study that region. . If we are buying a farm, we are 
not content with the State map or a geological chart 
including the estate in question. We demand an 
exact survey of that particular property, so that we 
may know what we are dealing with. This is just 
what regional, or, as it is sometimes called, surgical 
anatomy, does for the surgeon with reference to the 
part on which his skill is to be exercised. It enables 
him to see with the mind's eye through the opaque tis- 



224 MEDICAL ESSAYS. 

sues down to the bone on which they lie, as if the skin 
were transparent as the cornea, and the organs it cov- 
ers translucent as the gelatinous pulp of a medusa. 

It is curious that the Japanese should have antici- 
pated Europe in a kind of rude regional anatomy. I 
have seen a manikin of Japanese make traced all over 
with lines, and points marking their intersection. By 
this their doctors are guided in the performance of 
acupuncture, marking the safe places to thrust in nee- 
dles, as we buoy out our ship-channels, and doubtless 
indicating to learned eyes the spots where incautious 
meddling had led to those little accidents of shipwreck 
to which patients are unfortunately liable. 

A change of method, then, has given us General and 
Regional Anatomy. These, too, have been worked so 
thoroughly, that, if not exhausted, they have at least 
become to a great extent fixed and positive branches 
of knowledge. But the first of them, General Anat- 
omy, would never have reached this positive condition 
but for the introduction of that instrument which I 
have mentioned as the second great aid to modern 
progress. 

This instrument is the achromatic microscope. For 
the history of the successive steps by which it became 
the effective scientific implement we now possess, I 
must refer you to the work of Mr. Quekett, to an ex- 
cellent article in the " Penny Cyclopaedia," or to that 
of Sir David Brewster in the " Encyclopaedia Britan- 
niea," It is a most interesting piece of scientific his- 
tory, which shows how the problem which Biot in 1821 
pronounced insolvable was in the course of a few years 
practically solved, with a success equal to that which 
Dollond had long before obtained with the telescope. 
It is enough for our purpose that we are now in pos- 



BORDER LINES IN MEDICAL SCIENCE. 225 

session of an instrument freed from all confusions and 
illusions, which magnifies a thousand diameters, — a 
million times in surface, — without serious distortion 
or discoloration of its object. 

A quarter of a century ago, or a little more, an in- 
structor would not have hesitated to put John Bell's 
u Anatomy" and Bostock's " Physiology " into a stu- 
dent's hands, as good authority on their respective sub- 
jects. Let us not be unjust to either of these authors. 
John Bell is the liveliest medical writer that I can re- 
member who has written since the days of delightful old 
Ambroise Pare. His picturesque descriptions and bold 
figures are as good now as they ever were, and his book 
can never become obsolete. But listen to what John 
Bell says of the microscope : — 

" Philosophers of the last age had been at infinite 
pains to find the ultimate fibre of muscles, thinking to 
discover its properties in its form ; but they saw just 
in proportion to the glasses which they used, or to 
their practice and skill in that art, which is now almost 
forsaken." a 

Dr. Bostock's work, neglected as it is, is one which 
I value very highly as a really learned compilation, full 
of original references. But Dr. Bostock says : " Much 
as the naturalist has been indebted to the microscope, 
by bringing into view many beings of which he could 
not otherwise have ascertained the existence, the physi- 
ologist has not yet derived any great benefit from the 
instrument." b 

These are only specimens of the manner in which 
the microscope and its results were generally regarded 
by the generation just preceding our own. 

a Anat. and Phya. of the Human Body, i. 237. 
b Physiology, p. 281. 
15 



226 MEDICAL ESSAYS. 

I have referred you to the proper authorities for the 
account of those improvements which about the year 
1830 rendered the compound microscope an efficient 
and trustworthy instrument. It was now for the first 
time that a true general anatomy became possible. As 
early as 1816 Treviranus had attempted to resolve the 
tissues, of which Bichat had admitted no less than 
twenty-one, into their simple microscopic elements. 
How could such an attempt succeed, Henle well asks, a 
at a time when the most extensively diffused of all the 
tissues, the areolar, was not at all understood? All 
that method could do had been accomplished by Bichat 
and his followers. It w r as for the optician to take the 
next step. The future of anatomy and physiology, as 
an enthusiastic micrologist of the time said, was in the 
hands of Messrs. Schieck and Pistor, famous opticians 
of Berlin. 

In those earlier days of which I am speaking, all the 
points of minute anatomy were involved in obscurity. 
Some found globules everywhere, some fibres. Stu- 
dents disputed whether the conjunctiva extended over 
the cornea or not, and worried themselves over Gaul- 
tier de Claubry's stratified layers of the skin, or Bres- 
chet's blennogenous and chromatogenous organs. The 
dartos was a puzzle, the central spinal canal a myth, 
the decidua clothed in fable as much as the golden 
fleece. The structure of bone, now so beautifully made 
out, — even that of the teeth, in which old Leeuwen- 
hoek, peeping with his octogenarian eyes through the 
minute lenses wrought with his own hands, had long 
ago seen the " pipes," as lie called them, — was hardly 
known at all. The minute structure of the viscera lay 
in the mists of an uncertain microscopic vision. The 
8 Anatomie Generale (Trad, de Jourdan), i. 125. 



BORDER LINES IN MEDICAL SCIENCE. 227 

intimate recesses of the animal system were to the 
students of anatomy what the interior of Africa long 
was to geographers, and the stories of microscopic ex- 
plorers were as much sneered at as those of Bruce or 
Du Chaillu, and with better reason. 

Now what have we come to in our own day ? In the 
first place, the minute structure of all the organs has 
been made out in the most satisfactory way. The 
special arrangements of the vessels and the ducts of 
all the glands, of the air-tubes and vesicles of the lungs, 
of the parts which make up the skin and other mem- 
branes, all the details of those complex parenchyma- 
tous organs which had confounded investigation so long, 
have been lifted out of the invisible into the sight of 
all observers. It is fair to mention here, that we owe 
a great deal to the art of minute injection, by which 
we are enabled to trace the smallest vessels in the midst 
of the tissues where they axe distributed. This is an 
old artifice of anatomists. The famous Ruysch, who 
died a hundred and thirty years ago, showed that each 
of the viscera has its terminal vessels arranged in its 
own peculiar way ; a the same fact which you may see 
illustrated in Gerber's figures after the minute injec- 
tions of Berres. 6 I hope to show you many specimens 
of this kind in the microscope, the work of English 
and American hands. Professor Agassiz allows me 
also to make use of a very rich collection of injected 
preparations sent him by Professor Hyrtl, formerly of 
Prague, now of Vienna, for the proper exhibition of 
which I had a number of microscopes made expressly, 
by Mr. Grunow, during the past season. All this il- 
lustrates what has been done for the elucidation of the 
intimate details of formation of the organs. 

a Haller, Bill. Anat. i. 533. 

* General and Minute Anatomy (London, 1842), Plate XXIIL 



228 MEDICAL ESSAYS. 

But the great triumph of the microscope as applied 
to anatomy has been in the resolution of the organs 
and the tissues into their simple constituent anatomical 
elements. It has taken up general anatomy where 
Bichat left it. He had succeeded in reducing the 
structural language of nature to syllables, if you will 
permit me to use so bold an image. The microscopic 
observers who have come after him have analyzed these 
into letters, as we may call them, — the simple ele- 
ments by the combination of which Nature spells out 
successively tissues, which are her syllables, organs 
which are her words, systems which are her chapters, 
and so goes on from the simple to the complex, until 
she binds up in one living whole that wondrous volume 
of power and wisdom which we call the human body. 

The alphabet of the organization is so short and 
simple, that I will risk fatiguing your attention by re- 
peating it, according to the plan I have long adopted. 

A. Cells, either floating, as in the blood, or fixed, 
like those in the cancellated structure of bone, already 
referred to. Very commonly they have undergone a 
change of figure, most frequently a flattening which 
reduces them to scales, as in the epidermis and the 
epithelium. 

B. Simple, translucent, homogeneous solid, such as 
is found at the back of the cornea, or forming the in- 
tercellular substance of cartilage. 

C. The white fibrous element, consisting of very 
delicate, tenacious threads. This is the long staple 
textile substance of the body. It is to the organism 
what cotton is pretended to be to our Southern States. 
It pervades the whole animal fabric as areolar tissue, 
which is the universal packing and wrapping material. 
It forms the ligaments which bind the whole frame- 



BORDER LINES IN MEDICAL SCIENCE. 229 

work together. It furnishes the sinews, which are the 
channels of power. It enfolds every muscle. It wraps 
the brain in its hard, insensible folds, and the heart it- 
self beats in a purse that is made of it. 

D. The yellow elastic, fibrous element, the caout- 
chouc of the animal mechanism, which pulls things 
back into place, as the india-rubber band shuts the 
door we have opened. 

E. The striped muscular fibre, — the red flesh, 
which shortens itself in obedience to the will, and thus 
produces all voluntary active motion. 

F. The unstriped muscular fibre, more properly the 
fusiform-cell fibre, which carries on the involuntary 
internal movements. 

G. The nerve-cylinder, a glassy tube, with a pith 
of some firmness, which conveys sensation to the brain 
and the principle which induces motion from it. 

H. The nerve-corpuscle, the centre of nervous power. 

I. The mucous tissue, as Virchow calls it, common 
in embryonic structures, seen in the vitreous humor of 
the adult. 

To these add X, granules, of indeterminate shape 
and size, Y, for inorganic matters, such as the salts of 
bone and teeth, and Z, to stand as a symbol of the 
fluids, and you have the letters of what I have ventured 
to call the alphabet of the body. 

But just as in language certain diphthongs and syl- 
lables are frequently recurring, so we have in the body 
certain secondary and tertiary combinations, which we 
meet more frequently than the solitary elements of 
which they are composed. 

Thus A B, or a collection of cells united by simple 
structureless solid, is seen to be extensively employed 
in the body under the name of cartilage. Out of this 



230 MEDICAL ESSAYS. 

the surfaces of the articulations and the springs of the 
breathing apparatus are formed. But when Nature 
came to the buffers of the spinal column (interverte- 
bral disks) and the washers of the joints (semilunar 
fibro-cartilages of the knee, etc.), she required more 
tenacity than common cartilage possessed. What did 
she do ? What does man do in a similar case of need ? 
I need hardly tell you. The mason lays his bricks in 
simple mortar. But the plasterer works some hair into 
the mortar which he is going to lay in large sheets on 
the walls. The children of Israel complained that 
they had no straw to make their bricks with, though 
portions of it may still be seen in the crumbling pyra- 
mid of Darshour, which they are said to have built. 
I visited the old house on Witch Hill in Salem a year 
or two ago, and there I found the walls coated with 
clay in which straw was abundantly mingled ; — the 
old Judaizing witch-hangers copied the Israelites in a 
good many things. The Chinese and the Corsicans 
blend the fibres of amianthus in their pottery to give 
it tenacity. Now to return to Nature. To make her 
buffers and washers hold together in the shocks to 
which they would be subjected, she took common car- 
tilage and mingled the white fibrous tissue with it, to 
serve the same purpose as the hair in the mortar, the 
straw in the bricks and in the plaster of the old wall, 
and the amianthus in the earthen vessels. Thus we 
have the combination ABC, or fibro-cartttage. Again, 
the bones were once only gristle or cartilage, A B. 
To give them solidity they were infiltrated with stone, 
in the form of salts of lime, an inorganic element, 
so that bone would be spelt out by the letters A, B, 
and Y. 

If from these organic syllables we proceed to form 



BORDER LINES IN MEDICAL SCIENCE. 231 

organic words, we shall find that Nature employs three 
principal forms ; namely, Vessels, Membranes, and 
Parenchyma, or visceral tissue. The most complex of 
them can be resolved into a combination of these few 
simple anatomical constituents. 

Passing for a moment into the domain of Patho 
logical Anatomy, we find the same elements in mor- 
bid growths that we have met with in normal struc- 
tures. The pus-corjmscle and the white blood-corpuscle 
can only be distinguished by tracing them to their 
origin." A frequent form of so-called malignant dis- 
ease proves to be only a collection of altered epithelium- 
cells. Even cancer itself has no specific anatomical 
element, and the diagnosis of a cancerous tumor by 
the microscope, though tolerably sure under the eye of 
an expert, is based upon accidental, and not essential 
points, — the crowding together of the elements, the 
size of the cell-nuclei, and similar variable characters. 

Let us turn to Physiology. The microscope, which 
has made a new science of the intimate structure of 
the organs, has at the same time cleared up many un- 
certainties concerning the mechanism of the special 
functions. Up to the time of the living generation of 
observers, Nature had kept over all her inner work- 
shops the forbidding inscription, No Admittance ! If 
any prying observer ventured to spy through his mag- 
nifying tubes into the mysteries of her glands and 
canals and fluids, she covered up her work in blinding 
mists and bewildering halos, as the deities of old con- 
cealed their favored heroes in the moment of danger. 

° " Quite impossible to distinguish the two structures from 
each other " (in certain cases). Kolliker, 521. 



232 MEDICAL ESSAYS. 

Science has at length sifted the turbid light of her 
lenses, and blanched their delusive rainbows. 

Anatomy studies the organism in space. Physiol- 
ogy studies it also in time. After the study of form 
and composition follows close that of action, and this 
leads us along back to the first moment of the germ, 
and forward to the resolution of the living frame into 
its lifeless elements. In this way Anatomy, or rather 
that branch of it which we call Histology, has become 
inseparably blended with the study of function. The 
connection between the science of life and that of in- 
timate structure on the one hand, and composition on 
the other, is illustrated in the titles of two recent works 
of remarkable excellence, — " the Physiological Anat- 
omy " of Todd and Bowman, and the " Physiological 
Chemistry " of Lehmann. 

Let me briefly recapitidate a few of our acquisitions 
in Physiology, due in large measure to our new instru- 
ments and methods of research, and at the same time 
indicate the limits which form the permanent or the 
temporary boundaries of our knowledge. I will begin 
with the largest fact and with the most absolute and 
universally encountered limitation. 

The w * largest truth in Physiology" Mr. Paget con- 
siders to be " the development of ova through multi- 
plication and division of their cells." I would state 
it more broadly as the agency of the cell in all living 
processes. It seems at present necessary to abandon 
the original idea of Schwann, that we can observe 
the building up of a cell from the simple granules of 
a blastema, or formative fluid. The evidence points 
rather towards the axiom, Omnis cellula e ccllula ; 
that is, the germ of a new cell is always derived from 
a preexisting cell. The doctrine of Schwann, as I re- 



BORDER LINES IN MEDICAL SCIENCE. 233 

marked long ago (1844), runs parallel with the nebular 
theory in astronomy, and they may yet stand or fall 
together. 

As we have seen Nature anticipating the plasterer in 
fibro-cartilage, so we see her beforehand with the glass- 
blower in her dealings with the cell. The artisan 
blows his vitreous bubbles, large or small, to be used 
afterwards as may be wanted. So Nature shapes her 
hyaline vesicles and modifies them to serve the needs 
of the part where they are found. The artisan whirls 
his rod, and his glass bubble becomes a flattened disk, 
with its bull's-eye for a nucleus. These lips of ours are 
all glazed with microscopic tiles formed of flattened 
cells, each one of them with its nucleus still as plain 
and relatively as prominent, to the eye of the miero- 
scopist, as the bull's-eye in the old-fashioned window- 
pane. Everywhere we find cells, modified or un- 
changed. They roll in inconceivable multitudes (five 
millions and more to the cubic millimetre, according to 
Vierordt a ) as blood-disks through our vessels. A 
close-fitting mail of flattened cells coats our surface 
with a panoply of imbricated scales (more than twelve 
thousand millions, as Harting has computed 6 ), as true 
a defence against our enemies as the buckler of the ar- 
madillo or the carapace of the tortoise against theirs. 
The same little protecting organs pave all the great 
highways of the interior system. Cells, again, preside 
over the chemical processes which elaborate the living 
fluids ; they change their form to become the agents of 
voluntary and involuntary motion ; the soul itself sits 
on a throne of nucleated cells, and flashes its mandates 
through skeins of glassy filaments which once were 

* Kolliker, Manual, etc. (London, 1860J, p. 518. 
b Valentin's Physiology (Brinton's TransL), p. 13. 



234 MEDICAL ESSAYS. 

simple chains of vesicles. And, as if to reduce the 
problem of living force to its simplest expression, we 
see the yolk of a transparent egg dividing itself in 
whole or in part, and again dividing and subdividing, 
until it becomes a mass of cells, out of which the har- 
monious diversity of the organs arranges itself, worm 
or man, as God has willed from the beginning. 

This differentiation having been effected, each several 
part assumes its special office, having a life of its own 
adjusted to that of other parts and the whole. " Just 
as a tree constitutes a mass arranged in a definite man- 
ner, in which, in every single part, in the leaves as in 
the root, in the trunk as in the blossom, cells are dis- 
covered to be the ultimate elements, so is it also with 
the forms of animal life. Every animal presents 
itself as a sum of vital unities, every one of which 
manifests all the characteristics of life." ° 

The mechanism is as clear, as unquestionable, as ab- 
solutely settled and universally accepted, as the order 
of movement of the heavenly bodies, which we com- 
pute backward to the days of the observatories on the 
plains of Shinar, and on the faith of which we regulate 
the movements of war and trade by the predictions of 
our ephemeris. 

The mechanism, and that is all. We see the work- 
man and the tools, but the skill that guides the work 
and the power that performs it are as invisible as ever. 
I fear that not every listener took the significance of 
those pregnant words in the passage I quoted from 
John Bell, — " thinking to discover its properties in 
its form." We have discovered the working bee in 
this great hive of organization. We have detected the 
cell in the very act of forming itself from a nucleus, of 
• Virchow, Cellular Pathology, Lect. I. 



BORDER LINES IN MEDICAL SCIENCE. 235 

transforming itself into various tissues, of selecting the 
elements of various secretions. But why one cell be- 
comes nerve and another muscle, why one selects bile 
and another fat, we can no more pretend to tell, than 
why one grape sucks out of the soil the generous juice 
which princes hoard in their cellars, and another the 
wine which it takes three men to drink, — one to pour 
it down, another to swallow it, and a third to hold him 
while it is going down. Certain analogies between 
this selecting power and the phenomena of endosmosis 
in the elective affinities of chemistry we can find, but 
the problem of force remains here, as everywhere, un- 
solved and insolvable. 

Do we gain anything by attempting to get rid of the 
idea of a special vital force because we find certain 
mutually convertible relations between forces in the 
body and out of it ? I think not, any more than we 
should gain by getting rid of the idea and expression 
Magnetism because of its correlation with electricity. 
We may concede the unity of all forms of force, but 
we cannot overlook the fixed differences of its mani- 
festations according to the conditions under which it 
acts. It is a mistake, however, to think the mystery is 
greater in an organized body than in any other. We 
see a stone fall or a crystal form, and there is nothing 
stranger left to wonder at, for we have seen the Infi- 
nite in action. 

Just so far as we can recognize the ordinary modes 
of operation of the common forces of nature, — grav- 
ity, cohesion, elasticity, transudation, chemical action, 
and the rest, — we see the so-called vital acts in the 
light of a larger range of known facts and familiar 
analogies. Matteucci's well-remembered lectures con- 
tain many and striking examples of the working of 



236 MEDICAL ESSAYS. 

physical forces in physiological processes. Wherever 
rigid experiment carries us, we are safe in following 
this lead; but the moment we begin to theorize be- 
yond our strict observation, we are in danger of fall- 
ing into those mechanical follies which true science 
has long outgrown. 

Recognizing the fact, then, that we have learned 
nothing but the machinery of life, and are no nearer 
to its essence, what is it that we have gained by this 
great discovery of the cell formation and function ? 

It would have been reward enough to learn the" 
method Nature pursues for its own sake. If the sov- 
ereign Artificer lets us into his own laboratories and 
workshops, we need not ask more than the privilege 
of looking on at his work. We do not know where 
we now stand in the hierarchy of created intelligences. 
We were made a little lower than the angels. I speak 
it not irreverently ; as the lower animals surpass man 
in some of their attributes, so it may be that not every 
angel's eye can see as broadly and as deeply into the 
material works of God as man himself, looking at the 
firmament through an equatorial of fifteen inches' ap- 
erture, and searching into the tissues with a twelfth of 
an inch objective. 

But there are other positive gains of a more practi- 
cal character. Thus we are no longer permitted to 
place the seat of the living actions in the extreme ves- 
sels, which are only the carriers from which each part 
takes what it wants by the divine right of the omnipo- 
tent nucleated cell. The organism has become, in the 
words already borrowed from Virchow, "a sum of 
vital unities." The strictiim and la.ntm, the increased 
and diminished action of the vessels, out of which 
medical theories and methods of treatment have grown 



BORDER LINES IN MEDICAL SCIENCE. 237 

up, have yielded to the doctrine of local cell-communi- 
ties, belonging to this or that vascular district, from 
which they help themselves, as contractors are wont to 
do from the national treasury. 

I cannot promise to do more than to select a few of 
the points of contact between our ignorance and our 
knowledge which present particular interest in the ex- 
isting state of our physiological acquisitions. Some of 
them involve the microscopic discoveries of which I 
have been speaking, some belong to the domain of 
chemistry, and some have relations with other depart- 
ments of physical science. 

If we should begin with the digestive function, we 
should find that the long-agitated question of the na- 
ture of the acid of the gastric juice is becoming- settled 
in favor of the lactic. But the whole solvent agency 
of the digestive fluid enters into the category of that 
exceptional mode of action already familiar to us in 
chemistry as catalysis. It is therefore doubly difficult 
of explanation ; first, as being, like all reactions, a fact 
not to be accounted for except by the imaginative ap- 
peal to " affinity," and secondly, as being one of those 
peculiar reactions provoked by an element which 
stands outside and looks on without compromising it- 
self. 

The doctrine of Mulder, so widely diffused in popu- 
lar and scientific belief, of the existence of a common 
base of all albuminous substances, the so-called pro- 
tein, has not stood the test of rigorous analysis. The 
division of food into azotized and non-azotized is no 
doubt important, but the attempt to show that the first 
only is plastic or nutritive, while the second is simply 
calorifacient, or heat-producing, fails entirely in the 
face of the facts revealed by the study of man in dif- 



238 MEDICAL ESSAYS. 

ferent climates, and of numerous experiments in the 
feeding of animals. I must return to this subject in 
connection with the respiratory function. 

The sugar-making faculty of the liver is another 
" catalytic " mystery, as great as the rest of them, and 
no greater. Liver-tissue brings sugar out of the 
blood, or out of its own substance ; — why ? 

Quia est in co 

J 7/7 us saccharitiva. 

Just what becomes of the sugar beyond the fact of its 
disappearance before it can get into the general circu- 
lation and sweeten our tempers, it is hard to say. 

The pancreatic fluid makes an emulsion of the fat 
contained in our food, but just how the fatty particles 
get into the villi we must leave Briicke and Kolliker 
to settle if they can. 

No one has shown satisfactorily the process by which 
the blood-corpuscles are formed out of the lymph-cor- 
puscles, nor what becomes of them. These two ques- 
tions are like those famous household puzzles, — Where 
do the flies come from ? and, Where do the pins go to ? 

There is a series of organs in the body which has 
long puzzled physiologists, — organs of glandular as- 
pect, but having no ducts, — the spleen, the thyroid 
and thymus bodies, and the suprarenal capsules. We 
call them vascular glands, and we believe that they 
elaborate colored and uncolored blood-cells ; but just 
what changes they effect, and just how they effect 
them, it has proved a very difficult matter to deter- 
mine. So of the noted glandules which form Peyer's 
patches, their precise office, though seemingly like 
those of the lymphatic glands, cannot be positively as- 
signed, so far as I know, at the present time. It is of 



BORDER LINES IN MEDICAL SCIENCE. 239 

obvious interest to learn it with reference to the pa- 
thology of typhoid fever. It will be remarked that the 
coincidence of their changes in this disease with en- 
largement of the spleen suggests the idea of a similar- 
ity of function in these two organs. 

The theories of the production of animal heat, from 
the times of Black, Lavoisier, and Crawford to those 
of Liebig, are familiar to all w r ho have paid any atten- 
tion to physiological studies. The simplicity of Lie- 
big's views, and the popular form in which they have 
been presented, have given them wide currency, and 
incorporated them in the common belief and language 
of our text-books. Direct oxidation or combustion of 
the carbon and hydrogen contained in the food, or in 
the tissues themselves ; the division of alimentary sub- 
stances into respiratory, or non-azotized, and azotized, 
— these doctrines are familiar even to the classes in 
our high-schools. But this simple statement is boldly 
questioned. Nothing proves that oxygen combines (in 
the system) with hydrogen and carbon in particular, 
rather than with sulphur and azote. Such is the well- 
grounded statement of Robin and Verdeil. " It is 
very probable that animal heat is entirely produced 
by the chemical actions ivhich take place in the organ- 
ism, but the phenomenon is too complex to admit of 
our calculating it according to the quality of oxygen 
consumed." These last are the words of Regnault, as 
cited by Mr. Lewes, whose intelligent discussion of 
this and many of the most interesting physiological 
problems I strongly recommend to your attention. 

This single illustration covers a wider ground than 
the special function to which it belongs. We are 
learning that the chemistry of the body must be 
studied, not simply by its ingesta and egesta, but that 



240 MEDICAL ESSAYS. 

there is a long intermediate series of changes which 
must be investigated in their own light, under their 
own sj)ecial conditions. The expression " sum of vital 
unities " applies to the chemical actions, as well as to 
other actions localized in special parts ; and when the 
distinguished chemists whom I have just cited entitle 
their work a treatise on the immediate principles of 
the body, they only indicate the nature of that pro- 
found and subtile analysis which must take the place 
of all hasty generalizations founded on a comparison 
of the food with residual products. 

I will only call your attention to the fact, that the 
exceptional phenomenon of the laboratory is the pre- 
vailing law of the organism. Nutrition itself is but 
one great catalytic process. As the blood travels its 
rounds, each part selects its appropriate element and 
transforms it to its own likeness. Whether the ap- 
propriating agent be cell or nucleus, or a structureless 
solid like the intercellular substance of cartilage, the 
fact of its presence determines the separation of its 
proper constituents from the circulating fluid, so that 
even when we are wounded bone is replaced by bone, 
skin by skin, and nerve by nerve. 

It is hardly without a smile that we resuscitate the 
old question of the vis insita of the muscular fibre, so 
famous in the discussions of Haller and his contempo- 
raries. Speaking generally, I think we may say that 
Haller's doctrine is the one now commonly received ; 
namely, that the muscles contract in virtue of their 
own inherent endowments. It is true that Kolliker 
says no perfectly decisive fact has been brought for- 
ward to prove that the striated muscles contract with- 
out having been acted on by nerves. Yet Mr. Bow- 
man's observations on the contraction of isolated fibres 



BORDER LINES IN MEDICAL SCIENCE. 241 

appear decisive enough (unless we consider them in- 
validated by Dr. Lionel Beale's recent researches, 
tending to show that each elementary fibre is supplied 
with nerves a ) ; and as to the smooth muscular fibres, 
we have Virchow's statement respecting the contractil- 
ity of those of the umbilical cord, where there is not a 
trace of any nerves. 6 

In the investigation of the nervous system, anatomy 
and physiology have gone hand in hand. It is very 
singular that so important, and seemingly simple, a 
fact as the connection of the nerve -tubes, at their ori- 
gin or in their course, with the nerve-cells, should have 
so long remained open to doubt, as you may see that 
it did by referring to the very complete work of 
Sharpey and Quain (edition of 1849), the histologi- 
cal portion of which is cordially approved by Kolliker 
himself. c 

Several most interesting points of the minute anat- 
omy of the nervous centres have been laboriously and 
skilfully worked out by a recent graduate of this Med- 
ical School, in a monograph worthy to stand in line 
with those of Lockhart Clarke, Stilling, and Schroder 
van der Kolk. d I have had the privilege of examining 

° Proc. Royal Society, No. XL. vol. x., and British and Foreign 
Med. Chir. Review for April, 1861. 

6 See also the results of experiments with woorara and sulpho- 
cyanide of potassium. The first destroys the irritability of the 
nerves, the second that of the muscles. The student will find 
a notice of Bernard's experiments with these poisons in Dr. Dal- 
ton's standard work on Physiology, which, if he does not own, 
he should at once procure. 

c See also a learned note in Dr. Waldo I. Burnett's " Reviews 
and Abstracts," etc., American Journal of Science, September, 
1853. 

d Microscopic Anatomy of tire Lumbar Enlargement of the Spinal 
Cord. By John Dean, M. D. Cambridge, 1861. 
16 



242 MEDICAL ESSAYS. 

and of showing some of you a number of Dr. Dean's 
skilful preparations. I have no space to give even an 
abstract of his conclusions. I can only refer to his 
proof of the fact, that a single cell may send its proc- 
esses into several different bundles of nerve-roots (Fig. 
7, i?), and to his demonstration of the curved ascend- 
ing and descending fibres from the posterior nerve- 
roots, to reach what he has called the longitudinal 
columns of the cornua (Fig. 8, h, h). I must also 
mention Dr. Dean's exquisite microscopic photographs 
from sections of the medulla oblongata, winch appear 
to me to promise a new development, if not a new 
epoch, in anatomical art. 

It having been settled that the nerve-tubes can very 
commonly be traced directly to the nerve-cells, the 
object of all the observers in this department of anat- 
omy is to follow these tubes to their origin. We have 
an infinite snarl of telegraph wires, and we may be 
reasonably sure, that, if we can follow them up, we 
shall find each of them ends in a battery somewhere. 
One of the most interesting problems is to find the 
ganglionic origin of the great nerves of the medulla 
oblongata, and this is the end to which, by the aid of 
the most delicate sections, colored so as to bring out 
their details, mounted so as to be imperishable, mag- 
nified by the best instruments, and now self-recorded 
in the light of the truth-telling sunbeam, our fellow- 
student is making a steady progress in a labor which I 
think bids fair to rank with the most valuable contri- 
butions to histology that we have had from this side 
of the Atlantic. 

It is interesting to see how old questions are inci- 
dentally settled in the course of these new investiga- 
tions. Thus, Mr. Clarke's dissections, confirmed by 



BORDER LINES IN MEDICAL SCIENCE. 243 

preparations of Mr. Dean's which I have myself ex- 
amined, placed the fact of the decussation of the pyra- 
mids — denied by Haller, by Morgagni, and even by 
Stilling — beyond doubt. So the spinal canal, the ex- 
istence of which, at least in the adult, has been so often 
disputed, appears as a coarse and unequivocal anatomi- 
cal fact in many of the preparations referred to. 

While these studies of the structure of the cord have 
been going on, the ingenious and indefatigable Brown- 
Sequard has been investigating the functions of its 
different parts with equal diligence. The microscopic 
anatomists had shown that the ganglionic corpuscles 
of the gray matter of the cord are connected with each 
other by their processes, as well as with the nerve-roots. 
M. Brown-Sequard has proved by numerous experi- 
ments that the gray substance transmits sensitive 
impressions and muscular stimulation. The oblique 
ascending and descending fibres from the posterior 
nerve-roots, joining the " longitudinal columns of the 
cornua," a account for the results of Brown-Sequard's 
sections of the posterior columns. 6 The physiological 
experimenter has also made it evident that the decus- 
sation of the conductors of sensitive impressions has 
its seat in the spinal cord, and not in the encephalon, 
as had been supposed. Not less remarkable than these 
results are the facts, which I with others of my audi- 
ence have had the opportunity of observing, as shown 
by M. Brown-Sequard, of the artificial production of 
epilepsy in animals by injuring the spinal cord, and 
the induction of the paroxysm by pinching a certain 
portion of the skin. I would also call the student's 

a Dean's Memoir, Fig. 8. 

6 Lectures (Philadelphia, 1860), Lect. II. p. 26, and Plate I. 
fig. 7. 



244 MEDICAL ESSAYS. 

attention to his account of the relations of the nervous 
centres to nutrition and secretion, the last of which 
relations has been made the subject of an extended es- 
say by our fellow countryman, Dr. H. F. Campbell of 
Georgia. 

The physiology of the spinal cord seems a simple 
matter as you study it in Longet. The experiments of 
Brown-Sequard have shown the problem to be a com- 
plex one, and raised almost as many doubts as they 
have solved questions ; at any rate, I believe all lec- 
turers on physiology agree that there is no part of 
their task they dread so much as the analysis of the 
evidence relating to the special offices of the different 
portions of the medulla spinalis. In the brain we are 
sure that we do not know how to localize functions ; in 
the spinal cord, we think we do know something ; but 
there are so many anomalies, and seeming contradic- 
tions, and sources of fallacy, that beyond the facts of 
crossed paralysis of sensation, and the conducting 
agency of the gray substance, I am afraid we retain 
no cardinal principles discovered since the development 
of the reflex function took its place by Sir Charles 
Bell's great discovery. 

By the manner in which I spoke of the brain, you 
will see that I am obliged to leave phrenology sub 
Jove,— out in the cold, — as not one of the household 
of science. I am not one of its haters ; on the contrary, 
I am grateful for the incidental good it has done. I 
love to amuse myself in its plaster Golgothas, and lis- 
ten to the glib professor, as he discovers by his man- 
ipulations 

11 All that disgraced my betters met in me." 

I loved of old to see square-headed, heavy-jawed Spurz- 



BOEDER LINES IN MEDICAL SCIENCE. 245 

neim make a brain flower out into a corolla of marrowy 
filaments, as Vieussens had done before him, and to 
hear the dry-fibred but human-hearted George Combe 
teach good sense under the disguise of his equivocal 
system. But the pseudo-sciences, phrenology and the 
rest, seem to me only appeals to weak minds and the 
weak points of strong ones. There is apiece or false ap- 
petite in many intelligences ; they take to odd fancies in 
place of wholesome truth, as girls gnaw at chalk and 
charcoal. Phrenology juggles with nature. It is so 
adjusted as to soak up all evidence that helps it, and 
shed all that harms it. It crawls forward in all weath- 
ers, like Richard Edgeworth's hygrometer. It does 
not stand at the boundary of our ignorance, it seems to 
me, but is one of the will-o'-the-wisps of its undisputed 
central domain of bog and quicksand. Yet I should 
not have devoted so many words to it, did I not recog- 
nize the light it has thrown on human actions by its 
study of congenital organic tendencies. Its maps of 
the surface of the head are, I feel sure, founded on a 
delusion, but its studies of individual character are 
always interesting and instructive. 

The " snapping-turtle " strikes after its natural fash- 
ion when it first comes out of the egg. Children 
betray their tendencies in their way of dealing with 
the breasts that nourish them ; nay, I can venture to 
affirm, that long before they are born they teach their 
mothers something of their turbulent or quiet tempers. 
" Castor gaudet equis, ovo prognatus eodein 
Pugnis." 

Strike out the false pretensions of phrenology ; call it 
anthropology ; let it study man the individual in dis- 
tinction from man the abstraction, the metaphysical or 
theological lay-figure ; and it becomes " the proper 



246 MEDICAL ESSAYS. 

study of mankind," one of the noblest and most inter- 
esting of pursuits. 

The whole physiology of the nervous system, from 
the simplest manifestation of its power in an insect up 
to the supreme act of the human intelligence working 
through the brain, is full of the most difficult yet pro- 
foundly interesting questions. The singular relations 
between electricity and nerve-force, — relations which 
it has been attempted to interpret as meaning identity, 
in the face of palpable differences, require still more 
extended studies. You may be interested by Professor 
Faraday's statement of his opinion on the matter. 
" Though I am not satisfied that the nervous fluid is 
only electricity, still I think that the agent in the ner- 
vous system may be an inorganic force ; and if there 
be reason for supposing that magnetism is a higher 
relation of force than electricity, so it may well be im- 
agined that the nervous power may be of a still more 
exalted character, and yet within the reach of experi- 
ment." 

In connection with this statement, it is interesting to 
refer to the experiments of Helmholtz on the rapidity 
of transmission of the nervous actions. The rate is 
given differently in Valentin's report of these experi- 
ments and in that found in the " Scientific Annual " 
for 1858. One hundred and eighty to three hundred 
feet per second is the rate of movement assigned for 
sensation, but all such results must be very vaguely 
approximative. Boxers, fencers, players at the Italian 
game of mora, u prestidigitators," and all who depend 
for their success on rapidity of motion, know what dif- 
ferences there are in the personal equation of move- 
ment. 

Keflex action, the mechanical sympathy, if I may so 



BORDER LINES IN MEDICAL SCIENCE. 247 

call it, of distant parts ; Instinct, which, is crystallized 
intelligence, — an absolute law with its invariable 
planes and angles introduced into the sphere of con- 
sciousness, as rapliides are inclosed in the living cells 
of plants ; Intellect, — the operation of the thinking 
principle through material organs, with an appreciable 
waste of tissue in every act of thought, so that our 
clergymen's blood has more phosphates to get rid of 
on Monday than on any other day of the week ; Will, 
— theoretically the absolute determining power, prac- 
tically limited in different degrees by the varying 
organization of races and individuals, annulled or per- 
verted by different ill-understood organic changes ; — 
on all these subjects our knowledge is in its infancy, 
and from the study of some of them the interdict of the 
Vatican is hardly yet removed. 

I must allude to one or two points in the histology 
and physiology of the organs of sense. The anterior 
continuation of the retina beyond the ora serrata has 
been a subject of much discussion. If H. Miiller and 
Kolliker can be relied upon, this question is settled by 
recognizing that a layer of cells, continued from the 
retina, passes over the surface of the zonula Zinnii, but 
that no proper nervous element is so prolonged for- 
ward. 

I observe that Kolliker calls the true nervous ele- 
ments of the retina "the layer of gray cerebral sub- 
stance." In fact, the ganglionic corpuscles of each eye 
may be considered as constituting a little brain, con- 
nected with the masses behind by the co?nmissure, 
commonly called the optic nerve. We are prej)ared, 
therefore, to find these two little brains in the most 
intimate relations with each other, as we find the cere- 
bral hemispheres. We know that they are directly 



248 MEDICAL ESSAYS. 

connected by fibres that arch round through the chi- 
asnia. 

I mention these anatomical facts to introduce a 
physiological observation of my own, first announced 
in one of the lectures before the Medical Class, subse- 
quently communicated to the American Academy of 
Arts and Sciences, and printed in its u Transactions " 
for February 14, I860. I refer to the apparent trans- 
fer of impressions from one retina to the other, to which 
I have given the name reflex vision. The idea was 
suggested to me in consequence of certain effects 
noticed in employing the stereoscope. Professor Wil- 
liam B. Kodgers has since called the attention of the 
American Scientific Association to some facts bearing 
on the subject, and to a very curious experiment of 
Leonardo da Vinci's, which enables the observer to 
look through the palm of his hand (or seem to), as if 
it had a hole bored through it. As he and others hesi- 
tated to accept my explanation, I was not sorry to find 
recently the following words in the " Observations on 
Man " of that acute observer and thinker, David 
Hartley.* 

" An impression made on the right eye alone by a 
single object may propagate itself into the left, and 
there raise up an image almost equal in vividness to 
itself; and consequently when we see with one eye only, 
we may, however, have pictures in both eyes." Hart- 
ley, in 1784, had anticipated many of the doctrines 
which have since been systematized into the theory of 
reflex actions, and with which I have attempted to as- 
sociate this act of reflex vision. My sixth experiment, 
however, in the communication referred to, appears to 
me to be a crucial one, proving the correctness of my 
a Vol. i. p. 207. London, 1801. 



BORDER LINES IN MEDICAL SCIENCE. 249 

explanation, and I am not aware that it has been before 
instituted. 

Another point of great interest connected with the 
physiology of vision, and involved for a long time in 
great obscurity, is that of the adjustment of the eye to 
different distances. Dr. Clay Wallace of New York, 
who published a very ingenious little book on the eye 
about twenty years ago, with vignettes reminding one 
of Bewick, was among the first, if not the first, to de- 
scribe the ciliary muscle, to which the power of adjust- 
ment is generally ascribed. It is ascertained, by exact 
experiment with the phacueidoscope, that accommoda- 
tion depends on change of form of the crystalline lens. 
Where the crystalline is wanting, as Mr. Ware long 
ago taught, no power of accommodation remains. The 
ciliary muscle is generally thought to effect the change 
of form of the crystalline. The power of accommoda- 
tion is lost after the application of atropine, in conse- 
quence, as is supposed, of the paralysis of this muscle. 
This, I believe, is the nearest approach to a demonstra- 
tion we have on this point. 

I have only time briefly to refer to Professor Draper's 
most ingenious theory as to the photographic nature of 
vision, for an account of which I must refer to his 
original and interesting Treatise on Physiology. 

It were to be wished that the elaborate and very in- 
teresting researches of the Marquis Corti, which have 
revealed such singular complexity of structure in the 
cochlea of the ear, had done more to clear up its 
doubtful physiology ; but I am afraid we have nothing 
but hypotheses for the special part it plays in the act 
of hearing, and that we must say the same respecting 
the office of the semicircular canals. 

The microscope has achieved some of its greatest 



250 MEDICAL ESSAYS. 

triumphs in teaching us the changes which occur in 
the development of the embryo. No more interesting 
discovery stands recorded in the voluminous literature 
of this subject than the one originally announced by 
Martin Barry, afterwards discredited, and still later 
confirmed by Mr. Newport and others; namely the 
fact that the fertilizing filament reaches the interior of 
the ovum in various animals ; — a striking parallel to 
the action of the pollen-tube in the vegetable. But be- 
yond the mechanical facts all is mystery in the move- 
ments of organization, as profound as in the fall of a 
stone or the formation of a crystal. 

To the chemist and the microscopist the living body 
presents the same difficulties, arising from the fact 
that everything is in perpetual change in the organ- 
ism. The fibrine of the blood puzzles the one as much 
as its globules puzzle the other. The difference be- 
tween the branches of science which deal with space 
only, and those which deal with space and time, is 
this : we have no glasses that can magnify time. The 
figure I here show you a was photographed from an ob- 
ject (pleurosigma cmgulaturn) magnified a thousand 
diameters, or presenting a million times its natural 
surface. This other figure of the same object, en- 
larged from the one just shown, is magnified seven 
thousand diameters, or forty-nine million times in sur- 
face. When we can make the forty-nine millionth of a 
second as long as its integer, physiology and chemistry 
will approach nearer the completeness of anatomy. 

Our reverence becomes more worthy, or, if you will, 

° From a very interesting paper by Professor O. N. Rood of 
Albany, containing, with other views, the first microscopic stereo- 
graph I have seen. 



BORDER LINES IN MEDICAL SCIENCE. 251 

less unworthy of its Infinite Object in proportion as 
our intelligence is lifted and expanded to a higher and 
broader understanding of the Divine methods of action. 
If Galen called his heathen readers to admire "the 
power, the wisdom, the providence, the goodness of 
the Framer of the animal body," — if Mr. Boyle, the 
student of nature, as Addison and that friend of his 
who had known him for forty years tell us, never ut- 
tered the name of the Supreme Being without making 
a distinct pause in his speech, in token of his devout 
recognition of its awful meaning, — surely we, who 
inherit the accumulated wisdom of nearly two hundred 
years since the time of the British philosopher, and of 
almost two thousand since the Greek physician, may 
well lift our thoughts from the works we study to their 
great Artificer. These wonderful discoveries which we 
owe to that mighty little instrument, the telescope of 
the inner firmament with all its included worlds ; these 
simple formulae by which we condense the observations 
of a generation in a single axiom ; these logical analy- 
ses by which we fence out the ignorance we cannot re- 
claim, and fix the limits of our knowledge, — all lead 
us up to the inspiration of the Almighty, which gives 
understanding to the world's great teachers. To fear 
science or knowledge, lest it disturb our old beliefs, is 
to fear the influx of the Divine wisdom into the souls 
of our fellow-men ; for what is science but the piece- 
meal revelation, — uncovering, — of the plan of crea- 
tion, by the agency of those chosen prophets of nature 
whom God has illuminated from the central light of 
truth for that single purpose ? 

The studies which we have glanced at are prelim- 
inary in your education to the practical arts which 



252 MEDICAL ESSAYS. 

make use of them, — the arts of healing, — surgery and 
medicine. The more you examine the structure of the 
organs and the laws of life, the more you will find how 
resolutely each of the cell-republics which make up the 
E pluribus unum of the body maintains its independ- 
ence. Guard it, feed it, air it, warm it, exercise or 
rest it properly, and the working elements will do their 
best to keep well or to get well. What do we do with 
ailing vegetables? Dr. Warren, my honored prede- 
cessor in this chair, bought a country-place, including 
half of an old orchard. A few years afterwards I saw 
the trees on his side of the fence looking in good 
health, while those on the other side were scraggy and 
miserable. How do you suppose this change was 
brought about? By watering them with Fowler's 
solution ? By digging in calomel freely about their 
roots ? Not at all ; but by loosening the soil round 
them, and supplying them with the right kind of food 
in fitting quantities. 

Now a man is not a plant, or, at least, he is a very 
curious one, for he carries his soil in his stomach, 
which is a kind of portable flower-pot, and he grows 
round it, instead of out of it. He has, besides, a sin- 
gularly complex nutritive apparatus and a nervous 
system. But recollect the doctrine already enunciated 
in the language of Virchow, that an animal, like a 
tree, is a sum of vital unities, of which the cell is the 
ultimate element. Every healthy cell, whether in a 
vegetable or an animal, necessarily performs its func- 
tion properly so long as it is supplied with its proper 
materials and stimuli. A cell may, it is true, be con- 
genially defective, in which case disease is, so to 
speak, its normal state. But if originally sound and 
subsequently diseased, there has certainly been some 



BORDER LINES IN MEDICAL SCIENCE. 253 

excess, deficiency, or wrong qualit}^ in the materials or 
stimuli applied to it. You remove this injurious influ- 
ence and substitute a normal one ; remove the baked 
coal-ashes, for instance, from the roots of a tree, and 
replace them with loam ; take away the salt meat from 
the patient's table, and replace it with fresh meat and 
vegetables, and the cells of the tree or the man return 
to their duty. 

I do not know that we ever apply to a plant any 
element which is not a natural constituent of the vege- 
table structure, except perhaps externally, for the ac- 
cidental purpose of killing parasites. The whole art 
of cultivation consists in learning the proper food and 
conditions of plants, and supplying them. We give 
them water, earths, salts of various kinds such as they 
are made of, with a chance to help themselves to air 
and light. The farmer would be laughed at who un- 
dertook to manure his fields or his trees with a salt of 
lead or of arsenic. These elements are not constitu- 
ents of healthy plants. The gardener uses the waste 
of the arsenic furnaces to hill the weeds in his walks. 

If the law of the animal cell, and of the animal or- 
ganism, which is built up of such cells, is like that of 
the vegetable, we might expect that we should treat 
all morbid conditions of any of the vital unities be- 
longing to an animal in the same way, by increasing, 
diminishing, or changing its natural food or stimuli 

" That is an aliment which nourishes ; whatever we 
find in the organism, as a constant and integral ele- 
ment, either forming part of its structure, or one of 
the conditions of vital processes, that and that only 
deserves the name of aliment." a I see no reason, 
therefore, why iron, phosphate of lime, sulphur, should 
* Lewes, Physiology of Common Life, i. 76. 



254 MEDICAL ESSAYS. 

not be considered food for man, as much as guano or 
poudrette for vegetables. Whether one or another of 
them is best in any given case, — whether they shall 
be taken alone or in combination, in large or small 
quantities, — are separate questions. But they are 
elements belonging to the body, and even in moderate 
excess will produce little disturbance. There is no 
presumption against any of this class of substances, 
any more than against water or salt, provided they are 
used in fitting combinations, proportions, and forms. 

But when it comes to substances alien to the healthy 
system, which never belong to it as normal constitu- 
ents, the case is very different. There is a presump- 
tion against putting lead or arsenic into the human 
body, as against putting them into plants, because they 
do not belong there, any more than pounded glass, 
which, it is said, used to be given as a poison. The 
same thing is true of mercury and silver. What be- 
comes of these alien substances after they get into the 
system we cannot always tell. But in the case of sil- 
ver, from the accident of its changing color under the 
influence of light, we do know what happens. It is 
thrown out, in part at least, under the epidermis, and 
there it remains to the patient's dying day. This is a 
striking illustration of the difficulty which the system 
finds in dealing with non-assimilable elements, and jus- 
tifies in some measure the vulgar prejudice against 
" mineral poisons." 

I trust the youngest student on these benches will 
not commit the childish error of confounding a jjre- 
sumption against a particular class of agents with a 
condemnation of them. Mercury, for instance, is alien 
to the system, and eminently disturbing in its influ- 
ence. Yet its efficacy in certain forms of specific dis- 



BORDER LINES IN MEDICAL SCIENCE. 255 

ease is acknowledged by all but the most sceptical 
theorists. Even the esprit moqueur of Iiicord, the 
Voltaire of pelvic literature, submits to the time-hon- 
ored constitutional authority of this great panacea in 
the class of cases to which he has devoted his brilliant 
intelligence. Still, there is no telling what evils have 
arisen from the abuse of this mineral. Dr, Armstrong 
long ago pointed out some of them, and they have be- 
come matters of common notoriety. I am pleased, 
therefore, when I find so able and experienced a prac- 
titioner as Dr. Williams of this city proving that iritis 
is best treated without mercury, a and Dr. Vanderpoel 
showing the same thing to be true for pericarditis. 

Whatever elements nature does not introduce into 
vegetables, the natural food of all animal life, — di- 
rectly of herbivorous, indirectly of carnivorous ani- 
mals, — are to be regarded with suspicion. Arsenic- 
eating may seem to improve the condition of horses 
for a time, — and even of human beings, if Tschudi's 
stories can be trusted, — but it soon appears that its 
alien qualities are at war with the animal organization. 
So of copper, antimony, and other non-alimentary sim- 
ple substances ; every one of them is an intruder in 
the living system, as much as a constable would be, 
quartered in our household. This does not mean that 
they may not, any of them, be called in for a special 
need, as we send for the constable when we have good 
reason to think we have a thief under our roof ; but a 
man's body is his castle, as well as his house, and the 
presumption is that we are to keep our alimentary 
doors bolted against these perturbing agents. 

Now the feeling is very apt to be just contrary to 
this. The habit has been very general with well* 

a On the Treatment of Iritis without Mercury, Boston, 1856. 



256 MEDICAL ESSAYS. 

taught practitioners, to have recourse to the introduc- 
tion of these alien elements into the system on the 
occasion of any slight disturbance. The tongue was a 
little coated, and mercury must be given ; the skin was 
a little dry, and the patient must take antimony. It 
was like sending for the constable and the posse comi- 
tatits when there is only a carpet to shake or a refuse- 
barrel to empty." The constitution bears slow poisoning 
a great deal better than might be expected ; yet the 
most intelligent men in the profession have gradually 
got out of the habit of prescribing these powerful alien 
substances in the old routine way. Mr. Metcalf will 
tell you how much more sparingly they are given by 
our practitioners at the present time, than when he first 
inaugurated the new era of pharmacy among us. Still, 
the presumption in favor of poisoning out every spon- 
taneous reaction of outraged nature is not extinct in 
those who are trusted with the lives of their fellow- 
citizens. " On examining the file of prescriptions at 
the hospital, I discovered that they were rudely written, 
and indicated a treatment, as they consisted chiefly of 
tartar emetic, ipecacuanha, and epsom salts, hardly 
favorable to the cure of the prevailing diarrhoea and 
dysenteries." b In a report of a poisoning case now on 
trial, where we are told that arsenic enough was found 
in the stomach to produce death in twenty-four hours, 
the patient is said to have been treated by arsenic, 

a Dr. James Johnson advises persons not ailing to take five 
grains of blue pill with one or two of aloes twice a week for three 
or four months in the year, with half a pint of compound decoc- 
tion of sarsaparilla everyday for the same period, to preserve 
health and prolong life. Pract. Treatise on Dis. of Licer, etc. 
p. 272. 

* United States Sanitary Commission, Document No. 25. Re- 
port on a Regiment near Washington, dated July 9, 1861. 



BORDER LINES IN MEDICAL SCIENCE. 257 

phosphorus, bryonia, aconite, nux vomica, and muriatic 
acid, — by a practitioner of what school it may be im- 
agined. 

The traditional idea of always poisoning out disease, 
as we smoke out vermin, is now seeking its last refuge 
behind the wooden cannon and painted port-holes of 
that unblushing system of false scientific pretences 
which I do not care to name in a discourse addressed 
to an audience devoted to the study of the laws of nature 
in the light of the laws of evidence. It is extraordi- 
nary to observe that the system which, by its reducing 
medicine to a name and a farce, has accustomed all 
who have sense enough to see through its thin artifices 
to the idea that diseases get well without being " cured," 
should now be the main support of the tottering poi- 
son-cure doctrine. It has unquestionably helped to 
teach wise people that nature heals most diseases with- 
out help from pharmaceutic art, but it continues to 
persuade fools that art can arrest them all with its 
specifics. 

It is worse than useless to attempt in any way to 
check the freest expression of opinion as to the efficacy 
of any or all of the "heroic" means of treatment em- 
ployed by practitioners of different schools and periods. 
Medical experience is a great thing, but we must not 
forget that there is a higher experience, which tries its 
results in a court of a still larger jurisdiction ; that, 
namely, in which the laws of human belief are sum- 
moned to the witness-box, and obliged to testify to the 
sources of error which beset the medical practitioner. 
The verdict is as old as the father of medicine, who 
announces it in the words, "judgment is difficult." 
Physicians differed so in his time, that some denied 
that there was any such thing as an art of medicine. 
17 



258 MEDICAL ESSAYS. 

One man's best remedies were held as mischievous by 
another. The art of healing was like soothsaying, so 
the common people said ; the same bird was lucky or 
unlucky, according as he flew to the right or left. a 

The practice of medicine has undergone great changes 
within the period of my own observation. Venesec- 
tion, for instance, has so far gone out of fashion, that, 
as I am told by residents of the New York Bellevue 
and the Massachusetts General Hospitals, it is almost 
obsolete in these institutions, at least in medical prac- 
tice. 6 The old Brunonian stimulating treatment lias 
come into vogue again in the practice of Dr. Todd 
and his followers. The compounds of mercury have 
yielded their place as drugs of all work, and specifics 
for that very frequent subjective complaint, nescio quid 
fac'icuii, — to compounds of iodine/ Opium is believed 
in, and quinine, and "rum," using that expressive 
monosyllable to mean all alcoholic cordials. If Moliere 
were writing now, instead of saignare, purgare, and 
the other, he would be more like to say, Stimulare, 
opium dare et potassio-iodizare. 

I have been in relation successively with the Eng- 
lish and American evacuant and alterative practice, in 
which calomel and antimony figured so largely that, as 
you may see in Dr. Jackson's last "Letter," Dr. IIol- 
yoke, a good representative of sterling old-fashioned 

a Uep\ Aialrris '0{eW, § IV. v. 

* A similar change has taken place also in English surgical 
practice. Sir W. Napier speaks of " that inveterate use of the 
lancet, which disgraced the surgery of the times," — tlic early 
years of tins century. Life and Opinions of Sir Charles James 
Napier (London, 1857), vol. i. p. 153. 

e Sir Astley Cooper has the boldness, — or honesty, — to speak 
of medicines which "are given as much to assist the medical 
man as his patient." Lectures (London, 1832), p. 14. 



BORDER LINES IN MEDICAL SCIENCE. 259 

medical art, counted them with opium and Peruvian 
bark as his chief remedies ; with the moderately ex- 
pectant practice of Louis ; the blood-letting " coup sur 
coup " of Bouillaud ; the contra-stimulant method of 
Rasori and his followers; the anti-irritant system of 
Broussais, with its leeching and gum-water ; I have 
heard from our own students of the simple opium prac- 
tice of the renowned German teacher, Oppolzer ; and 
now I find the medical community brought round by 
the revolving cycle of opinion to that same old plan of 
treatment which John Brown taught in Edinburgh in 
the last quarter of the last century, and Miner and Tully 
fiercely advocated among ourselves in the early years of 
the present. The worthy physicians last mentioned, and 
their antagonist Dr. Gallup, used stronger language 
than we of these degenerate days permit ourselves. 
" The lancet is a weapon which annually slays more 
than the sword," says Dr. Tully. "It is probable 
that, for forty years past, opium and its preparations 
have done seven times the injury they have rendered 
benefit, on the great scale of the world," says Dr. Gallup. 
What is the meaning of these perpetual changes 
and conflicts of medical opinion and practice, from an 
early antiquity to our own time ? Simply this : all 
" methods " of treatment end in disappointment of 
those extravagant expectations which men are wont to 
entertain of medical art. The bills of mortality are 
more obviously affected by drainage, than by this or 
that method of practice. The insurance companies do 
not commonly charge a different percentage on the 
lives of the patients of this or that physician. In the 
course of a generation, more or less, physicians them- 
selves are liable to get tired of a practice which has 
so little effect upon the average movement of vital 



260 MEDICAL ESSAYS. 

decomposition. Then they are ready for a change, 
even if it were back again to a method which has al- 
ready been tried, and found wanting. 

Our practitioners, or many of them, have got back 
to the ways of old Dr. Samuel Danforth, who, as it is 
well known, had strong objections to the use of the 
lancet. By and by a new reputation will be made by 
some discontented practitioner, who, tired of seeing 
patients die with their skins full of whiskey and their 
brains muddy with opium, returns to a bold antiphlo- 
gistic treatment, and has the luck to see a few patients 
of note get well under it. So of the remedies which 
have gone out of fashion and been superseded by 
others. It can hardly be doubted that they will come 
into vogue again, more or less extensively, under the 
influence of that irresistible demand for change just 
referred to. 

Then will come the usual talk about a change in the 
character of disease, which has about as much mean- 
ing as that concerning " old-fashioned snow-storms." 
" Epidemic constitutions " of disease mean something, 
no doubt ; a great deal as applied to malarious affec- 
tions ; but that the whole type of diseases undergoes 
such changes that the practice must be reversed from 
depleting to stimulating, and vice versa, is much less 
likely than that methods of treatment go out of fash- 
ion and come in again. If there is any disease which 
claims its percentage with reasonable uniformity, it is 
phthisis. Yet I remember that the reverend and ven- 
erable Dr. Prince of Salem told me one Commence- 
ment day, as I was jogging along towards Cambridge 
with him, that he recollected the time when that dis- 
ease was hardly known; and in confirmation of his 
statement mentioned a case in which it was told as a 



BORDER LINES IN MEDICAL SCIENCE. 261 

great event, that somebody down on " the Cape " had 
died of " a consumption." This story does not sound 
probable to myself, as I repeat it, yet I assure you it 
is true, and it shows how cautiously we must receive 
all popular stories of great changes in the habits of 
disease." 

Is there no progress, then, but do we return to the 
same beliefs and practices which our forefathers wore 
out and threw away? I trust and believe that there 
is a real progress. We may, for instance, return in 
a measure to the Brunonian stimulating system, but it 
must be in a modified way, for we cannot go back to 
the simple Brunonian pathology, since we have learned 
too much of diseased action to accept its convenient 
dualism. So of other doctrines, each new Avatar 
strips them of some of their old pretensions, until they 
take their fitting place at last, if they have any truth 
in them, or disappear, if they were mere phantasms 
of the imagination. 

In the mean time, while medical theories are com- 
ing in and going out, there is a set of sensible men 
who are never run away with by them, but practise 
their art sagaciously and faithfully in much the same 
way from generation to generation. From the time 
of Hippocrates to that of our own medical patriarch, 
there has been an apostolic succession of wise and good 
practitioners. If you will look at the first aphorism 
of the ancient Master you will see that before all rem- 
edies he places the proper conduct of the patient and 
his attendants, and the fit ordering of all the condi- 
tions surrounding him. The class of practitioners I 

a See Brit, and For. Med.-CMr. Rev. for October, 1860, p. 239. 
The last two paragraphs were in type before I had seen the ar- 
ticle here referred to. 



262 MEDICAL ESSAYS. 

have referred to have always been the most faithful in 
attending to these points. No doubt they have some- 
times prescribed unwisely, in compliance with the 
prejudices of their time, but they have grown wiser as 
they have grown older, and learned to trust more in 
nature and less in their plans of interference. I believe 
common opinion confirms Sir James Clark's observa- 
tion to this effect. 

The experience of the profession must, I think, run 
parallel with that of the wisest of its individual mem- 
bers. Each time a plan of treatment or a particular 
remedy comes up for trial, it is submitted to a sharper 
scrutiny. When Cullen wrote his Materia Medica, he 
had seriously to assail the practice of giving burnt 
toad, which was still countenanced by at least one 
medical authority of note. I have read recently in 
some medical journal, that an American practitioner, 
Avhose name is known to the country, is prescribing 
the hoof of a horse for epilepsy. It was doubtless sug- 
gested by that old fancy of wearing a portion of elk's- 
hoof hung round the neck or in a ring, for this disease. 
But it is hard to persuade reasonable people to swal- 
low the abominations of a former period. The evi- 
dence which satisfied Fernelius will not serve one of 
our hospital physicians. 

In this way those articles of the Materia Medica 
winch had nothing but loathsomeness to recommend 
them have been gradually dropped, and are not like 
to obtain any general favor again with civilized com- 
munities. The next culprits to be tried are the poi- 
sons. I have never been in the least sceptical as to 
the utility of some of them, when properly employed. 
Though I believe that at present, taking the world at 
large, and leaving out a few powerful agents of such 



BORDER LINES IN MEDICAL SCIENCE. 263 

immense value that they rank next to food in impor- 
tance, the poisons prescribed for disease do more hurt 
than good, I have no doubt, and never professed to 
have any, that they do much good in prudent and in- 
structed hands. But I am very willing to confess a 
great jealousy of many agents, and I could almost wish 
to see the Materia Medica so classed as to call sus- 
picion upon certain ones among them. 

Thus the alien elements, those which do not prop- 
erly enter into the composition of any living tissue, are 
the most to be suspected, — mercury, lead, antimony, 
silver, and the rest, for the reasons I have before men- 
tioned. Even iodine, which, as it is found in certain 
plants, seems less remote from the animal tissues, gives 
unequivocal proofs from time to time that it is hostile 
to some portions of the glandular system. 

There is, of course, less primd facie objection to 
those agents which consist of assimilable elements, 
such as are found making a part of healthy tissues. 
These are divisible into three classes, — foods, poisons, 
and inert, mostly because insoluble, substances. The 
food of one animal or of one human being is some- 
times poison to another, and vice versa; inert sub- 
stances may act mechanically, so as to produce the 
effect of poisons ; but this division holds exactly 
enough for our purpose. 

Strictly speaking, every poison consisting of assimi- 
lable elements may be considered as univholesome 
food. It is rejected by the stomach, or it produces 
diarrhoea, or it causes vertigo or disturbance of the 
heart's action, or some other symptom for which the 
subject of it would consult the physician, if it came on 
from any other cause than taking it under the name 
of medicine. Yet portions of this unwholesome food 



264 MEDICAL ESSAYS. 

which we call medicine, we have reason to believe, are 
assimilated ; thus, castor-oil appears to be partially di- 
gested by infants, so that they require large doses to 
affect them medicinally. Even that deadliest of poi- 
sons, hydrocyanic acid, is probably assimilated, and 
helps to make living tissue, if it do not kill the pa- 
tient, for the assimilable elements which it contains, 
given in the separate forms of amygdalin and emuU 
sin, produce no disturbance, unless, as in Bernard's 
experiments, they are suffered to meet in the digestive 
organs. A medicine consisting of assimilable sub- 
stances being then simply unwholesome food, we un- 
derstand what is meant by those cumulative effects of 
such remedies often observed, as in the case of digi- 
talis and strychnia. They are precisely similar to the 
cumulative effects of a salt diet in producing scurvy, 
or of spurred rye in producing dry gangrene. As the 
effects of such substances arc a violence to the organs, 
we should exercise the same caution with regard to 
their use that we would exercise about any other kind 
of poisonous food, — partridges at certain seasons, for 
instance. Even where these poisonous kinds of food 
seem to be useful, we should still regard them with 
great jealousy. Digitalis lowers the pulse in febrile 
conditions. Veratrum viride does the same thing. 
How do we know that a rapid pulse is not a normal 
adjustment of nature to the condition it accompanies? 
Digitalis lias gone out of favor ; how sure are we that 
Veratrum viride will not be found to do more harm 
than good in a case of internal inflammation, taking 
the whole course of the disease into consideration ? 
Think of the change of opinion with regard to the use 
of opium in delirium tremens (which you remember is 
sometimes called delirium vigilans), where it seemed 



BOEDER LINES IN MEDICAL SCIENCE. 265 

so obviously indicated, since the publication of Dr. 
Ware's admirable essay. I respect the evidence of my 
contemporaries, but I cannot forget the sayings of the 
Father of medicine, — Ars long a, judicium difficile. 

I am not presuming to express an opinion concern- 
ing Veratrum viride, which was little heard of when 
I was still practising medicine. I am only appealing 
to that higher court of experience which sits in judg- 
ment on all decisions of the lower medical tribunals, 
and which requires more than one generation for its 
final verdict. 

Once change the habit of mind so long prevalent 
among practitioners of medicine ; once let it be every- 
where understood that the presumption is in favor of 
food, and not of alien substances, of innocuous, and 
not of unwholesome food, for the sick ; that this pre- 
sumption requires very strong evidence in each partic- 
ular case to overcome it ; but that, when such evidence 
is afforded, the alien substance or the unwholesome 
food should be given boldly, in sufficient quantities, in 
the same spirit as that with which the surgeon lifts his 
knife against a patient, — that is, with the same reluc- 
tance and the same determination, — and I think we 
shall have and hear much less of charlatanism in and 
out of the profession. The disgrace of medicine has 
been that colossal system of self-deception, in obedi- 
ence to which mines have been emptied of their can- 
kering minerals, the vegetable kingdom robbed of all 
its noxious growths, the entrails of animals taxed for 
their impurities, the poison-bags of reptiles drained of 
their venom, and all the inconceivable abominations 
thus obtained thrust down the throats of human beings 
suffering from some fault of organization, nourishment, 
c> vital stimulation. 



266 MEDICAL ESSAYS. 

Much as we have gained, we have not yet thor- 
oughly shaken off the notion that poison is the natural 
food of disease, as wholesome aliment is the support of 
health. Cowper's lines, in "The Task,"' show the mat- 
ter-of-course practice of his time : — 

" He does not scorn it, who has long endured 
A fever's agonies, and fed on drugs." 

Dr. Kimball of Lowell, who has been in the habit of 
seeing a great deal more of typhoid fever than most 
practitioners, and whose surgical exploits show him 
not to be wanting in boldness or enterprise, can tell 
you whether he finds it necessary to feed his patients 
on drugs or not. His experience is, I believe, that of 
the most enlightened and advanced portion of the pro- 
fession ; yet I think that even in typhoid fever, and 
certainly in many other complaints, the effects of an- 
cient habits and prejudices may still be seen in the 
practice of some educated physicians. 

To you, young men, it belongs to judge all that has 
gone before you. You come nearer to the great fa- 
thers of modern medicine than some of you imagine. 
Three of my own instructors attended Dr. Rush's Lec- 
tures. The illustrious Haller mentions Rush's inau- 
gural thesis B in his " Bibliotheca Anatomica ; " and 
this same Haller, brought so close to us, tells us he re- 
members Ruysch, then an old man, and used to carry 
letters between him and Boerhaave.* Look through 
the history of medicine from Boerhaave to this present 
day. You will see at once that medical doctrine and 
practice have undergone a long series of changes. You 

° De Coctione Ciborum in Venlriculo. Edinb. 17G8. — Bibl 
Annt. ii. G.")7. 

6 l ' Ssepissime bonum senem vidi, saepe Bokrhaavidm inter 
et ipsum iiterarani vector." — Ibid. i. 529. 



BORDER LINES IN MEDICAL SCIENCE. 267 

will see that the doctrine and practice of our own time 
must probably change in their turn, and that, if we 
can trust at all to the indications of their course, it 
will be in the direction of an improved hygiene and a 
simplified treatment. Especially will the old habit of 
violating the instincts of the sick give place to a judi- 
cious study of these same instincts. It will be found 
that bodily, like mental insanity, is best managed, for 
the most part, by natural soothing agencies. Two cen- 
turies ago there was a prescription for scurvy contain- 
ing "stercoris taurini et anserini par quantitas trium 
magnarum nucum" of the hell-broth containing which 
" quoties-cumque sitit ceger, large bibit." a When I 
have recalled the humane common-sense of Captain 
Cook in the matter of preventing this disease ; when I 
have heard my friend, Mr. Dana, describing the avid- 
ity with which the scurvy-stricken sailors snuffed up 
the earthy fragrance of fresh raw potatoes, the food 
which was to supply the elements wanting to their 
spongy tissues, I have recognized that the perfection 
of art is often a return to nature, and seen in this sin- 
gle instance the germ of innumerable beneficent future 
medical reforms. 

I cannot help believing that medical curative treat- 
ment will by and by resolve itself in great measure 
into modifications of the food, swallowed and breathed, 
and of the natural stimuli, and that less will be ex- 
pected from specifics and noxious disturbing agents, 
either alien or assimilable. The noted mineral-waters 
containing iron, sulphur, carbonic acid, supply nutri- 
tious or stimulating materials to the body as much as 
phosphate of lime and ammoniacal compounds do to 
the cereal plants. The effects of a milk and vegetable 

• Schenck, Observ. Med. Bar. (Lugduni, 1643), p. 800. 



268 MEDICAL ESSAYS. 

diet, of gluten bread in diabetes, of cod-liver oil in 
phthisis, even of such audacious innovations as the 
water-cure and the grape-cure, are only hints of what 
will be accomplished when we have learned to discover 
what organic elements are deficient or in excess in a 
case of chronic disease, and the best way of correcting 
the abnormal condition, just as an agriculturist ascer- 
tains the wants of his crops and modifies the composi- 
tion of his soil. In acute febrile diseases we have lon£ 
ago discovered that far above all drug-medication is 
the use of mild liquid diet in the period of excitement, 
and of stimulant and nutritious food in that of ex- 
haustion. Hippocrates himself was as particular about 
his barley-ptisan as any Florence Nightingale of our 
time could be. 

The generation to which you, who are just entering 
the profession, belong, will make a vast stride forward, 
as I believe, in the direction of treatment by natural 
rather than violent agencies. What is it that makes 
the reputation of Sydenham, as the chief of English 
physicians ? His prescriptions consisted principally of 
simples. An aperient or an opiate, a " cardiac " or a 
tonic, may be commonly found in the midst of a some- 
what fantastic miscellany of garden herbs. It was not 
by his pharmaceutic prescriptions that he gained his 
great name. It was by daring to order fresh air for 
small-pox patients, and riding on horseback for con- 
sumptives, in place of the smothering system, and the 
noxious and often loathsome rubbish of the established 
schools. Of course Sydenham was much abused by 
his contemporaries, as he frequently takes occasion to 
remind his reader. " I must needs conclude," he says, 
" either that I am void of merit, or that the candid 
and ingenuous part of mankind, who are formed with 



BORDER LINES IN MEDICAL SCIENCE. 269 

so excellent a temper of mind as to be no strangers to 
gratitude, make a very small part of the whole." a If 
in the fearless pursuit of truth you should find the 
world as ungracious in the nineteenth century as he 
found it in the seventeenth, you may learn a lesson of 
self-reliance from another utterance of the same illus- 
trious physician : " 'T is none of my business to inquire 
what other persons think, but to establish my own ob- 
servations ; in order to which, I ask no favor of the 
reader but to peruse my writings with temper." b 

The physician has learned a great deal from the 
surgeon, who is naturally in advance of him, because 
he has a better opportunity of seeing the effects of his 
remedies. Let me shorten one of Ambroise Pare's 
stories for you. There had been a great victory at the 
pass of Susa, and they were riding into the city. The 
wounded cried out as the horses trampled them under 
their hoofs, which caused good Ambroise great pity, 
and made him wish himself back in Paris. Going into 
a stable he saw four dead soldiers, and three desper- 
ately wounded, placed with their backs against the 
wall. An old campaigner came up. — " Can these fel- 
lows get well? " he said. " No ! " answered the sur- 
geon. Thereupon, the old soldier walked up to them 
and cut all their throats, sweetly, and without wrath 
(doulcement et sans cholere). Ambroise told him he 
was a bad man to do such a thing. " I hope to God," 
he said, " somebody will do as much for me if I ever 
get into such a scrape " (aceoustre de telle fagon). 
" I was not much salted in those days " (bien cloux de 
seZ), says Ambroise, " and little acquainted with the 

* Of the Small-Pox and Hysteric Diseases. Epistle to Dr. Wil- 
liam Cole, § 140, Swan's Translation. 
6 Works, Preface, p. xxi. 



270 MEDICAL ESSAYS. 

treatment of wounds." However, as he tells us, he 
proceeded to apply boiling oil of Sambuc (elder) after 
the approved fashion of the time, — with what torture 
to the patient may be guessed. At last his precious 
oil gave out, and he used instead an insignificant mix- 
ture of his own contrivance. He could not sleep that 
night for fear his patients who had not been scalded 
with the boiling oil would be poisoned by the gunpow- 
der conveyed into their wounds by the balls. To his 
surprise, he found them much better than the others 
the next morning, and resolved never again to burn 
his patients with hot oil for gun-shot wounds. a 

This was the beginning, as nearly as we can fix it, 
of that reform which has introduced plain water-dress- 
ings in the place of the farrago of external applications 
which had been a source of profit to apothecaries and 
disgrace to art from, and before, the time when Pliny 
complained of them. A young surgeon who was at 
Sudley Church, laboring among the wounded of Bull 
Run, tells me they had nothing but water for dressing, 
and he (being also doux de seT) was astonished to see 
how well the wounds did under that simple treatment. 

Let me here mention a fact or two which may be of 
use to some of you who mean to enter the public ser- 
vice. You will, as it seems, have gun-shot wounds al- 
most exclusively to deal with. Three different sur- 
geons, the one just mentioned and two who saw the 
wounded of Big Bethel, assured me that they found no 
sabre-cuts or bayonet wounds. It is the rifle-bullet 
from a safe distance which pierces the breasts of our 
soldiers, and not the gallant charge of broad platoons 
and sweeping squadrons, such as we have been in the 

° Le Voyage de Thurin, LEucrcs (Paris, 1579), p. 1108. 



BORDER LINES IN MEDICAL SCIENCE. 271 

habit of considering the chosen mode of warfare of 
ancient and modern chivalry." 

Another fact parallels the story of the old cam- 
paigner, and may teach some of you caution in se- 
lecting your assistants. A chaplain told it to two of 
our officers personally known to myself. He overheard 
the examination of a man who wished to drive one of 
the " avalanche " wagons, as they call them. The man 
was asked if he knew how to deal with wounded men. 
" Oh yes," he answered ; " if they 're hit here" point- 
ing to the abdomen, " knock 'em on the head, — they 
can't get well." 

In art and outside of it you will meet the same bar- 
barisms that Ambroise Pare met with, — for men differ 
less from century to century than we are apt to sup- 
pose ; you will encounter the same opposition, if you 
attack any prevailing opinion, that Sydenham com- 
plained of. So far as possible, let not such experi- 
ences breed in you a contempt for those who are the 
subjects of folly or prejudice, or foster any love of dis- 
pute for its own sake. Should you become authors, 
express your opinions freely ; defend them rarely. It 
is not often that an opinion is worth expressing, which 

a Sir Charles James Napier had the same experience in Vir- 
ginia in 1813. "Potomac. We have nasty sort of fighting here, 
amongst creeks and bushes, and lose men without show." 
" Yankee never shows himself, he keeps in the thickest wood, 
fires and runs off." "These five thousand in the open field 
might be attacked, but behind works it would be throwing away 
lives." He calls it " an inglorious warfare," — says one of the 
leaders is "a little deficient in gumption," — but "still my 
opinion is, that if we tuck up our sleeves and lay our ears back 
we might thrash them ; that is, if we caught them out of their 
trees, so as to slap at them with the bayonet." — Life, etc. vol. 
i. p. 218 et seq. 



272 MEDICAL ESSAYS. 

cannot take care of itself. Opposition is the best mor- 
dant to fix the color of your thought in the general 
belief. 

It is time to bring these crowded remarks to a close. 
The day has been when at the beginning of a course of 
Lectures I should have thought it fitting to exhort 
you to diligence and entire devotion to your tasks as 
students. It is not so now. The young man who has 
not heard the clarion-voices of honor and of duty now 
sounding throughout the land, will heed no word of 
mine. In the camp or the city, in the field or the 
hospital, under sheltering roof, or half-protecting can- 
vas, or open sky, shedding our own blood or stanching 
that of our wounded defenders, students or teachers, — 
whatever our calling and our ability, we belong, not to 
ourselves, but to our imperilled country, whose danger 
is our calamity, whose ruin would be our enslavement, 
whose rescue shall be our earthly salvation ! 






SCHOLASTIC AND BEDSIDE TEACHING. 3 

The idea is entertained by some of our most sincere 
professional brethren, that to lengthen and multiply 
our Winter Lectures will be of necessity to advance 
the cause of medical education. It is a fair subject 
for consideration whether they do not overrate the 
relative importance of that particular mode of instruc- 
tion which forms the larger part of these courses. 

As this School could only lengthen its lecture term 
at the expense of its " Summer Session," in which 
more direct, personal, and familiar teaching takes the 
place of our academic discourses, and in which more 
time can be given to hospitals, infirmaries, and prac- 
tical instruction in various important specialties, what- 
ever might be gained, a good deal would certainly be 
lost in our case by the exchange. 

The most essential part of a student's instruction is 
obtained, as I believe, not in the lecture-room, but at 
the bedside. Nothing seen there is lost ; the rhythms 
of disease are learned by frequent repetition ; its un- 
foreseen occurrences stamp themselves indelibly in the 
memory. Before the student is aware of what he has 
acquired, he has learned the aspects and course and 
probable issue of the diseases he has seen with his 
teacher, and the proper mode of dealing with them, so 

° An Introductory Lecture delivered before the Medical Class 
of Harvard University, November 6, 1867. 
18 



274 MEDICAL ESSAYS. 

far as his master knows it. On the other hand, our 
ex cathedra prelections have a strong tendency to run 
into details which, however interesting they may be to 
ourselves and a few of our more curious listeners, have 
nothing in them which will ever be of use to the stu- 
dent as a practitioner. It is a perfectly fair question 
whether I and some other American Professors do not 
teach quite enough that is useless already. Is it not 
well to remind the student from time to time that a 
physician's business is to avert disease, to heal the sick, 
to prolong life, and to diminish suffering? Is it not 
true that the young man of average ability will find it 
as much as he can do to fit himself for these simple 
duties ? Is it not best to begin, at any rate, by making 
sure of such knowledge as he will require in his daily 
walk, by no means discouraging him from any study 
for which his genius fits him when he once feels that 
he has become master of his chosen art. 

I know that many branches of science are of the 
greatest value as feeders of our medical reservoirs. 
But the practising physician's office is to draw the 
healing waters, and while he gives his time to this 
labor he can hardly be expected to explore all the 
sources that spread themselves over the wide domain 
of science. The traveller who would not drink of the 
Nile until he had tracked it to its parent lakes, would 
be like to die of thirst ; and the medical practitioner 
who would not use the results of many laborers in 
other departments without sharing their special toils, 
would find life far too short and art immeasurably too 
long. 

We owe much to Chemistry, one of the most capti- 
vating as well as important of studies ; but the medical 
man must as a general rule content himself with a 



SCHOLASTIC AND BEDSIDE TEACHING. 275 

clear view of its principles and a limited acquaintance 
with its facts ; such especially as are pertinent to his 
pursuits. I am in little danger of underrating Anat- 
omy or Physiology ; but as each of these branches 
splits up into specialties, any one of which may take 
up a scientific life-time, I would have them taught with 
a certain judgment and reserve, so that they shall not 
crowd the more immediately practical branches. So 
of all the other ancillary and auxiliary kinds of knowl- 
edge, I would have them strictly subordinated to that 
particular kind of knowledge for which the community 
looks to its medical advisers. 

A medical school is not a scientific school, except 
just so far as medicine itself is a science. On the nat- 
ural history side, medicine is a science ; on the cura- 
tive side, chiefly an art. This is implied in Hufeland's 
aphorism : " The physician must generalize the disease 
and individualize the patient." 

The coordinated and classified results of empirical 
observation, in distinction from scientific experiment, 
have furnished almost all we know about food, the 
medicine of health, and medicine, the food of sickness. 
We eat the root of the Solanum tuberosum and throw 
away its fruit ; we eat the fruit of the Solanum Ly- 
copersicum and throw away its root. Nothing but vul- 
gar experience has taught us to reject the potato ball 
and cook the tomato. So of most of our remedies. 
The subchloride of mercury, calomel, is the great Brit- 
ish specific ; the protochloride of mercury, corrosive 
sublimate, kills like arsenic, but no chemist could have 
told us it would be so. 

From observations like these we can obtain certain 
principles from which we can argue deductively to 
facts of a like nature, but the process is limited, and 



276 MEDICAL ESSAYS. 

we are suspicious of all reasoning in that direction ap- 
plied to the processes of healthy and diseased life. We 
are continually appealing to special facts. We are 
willing to give Liebig's artificial milk when we cannot 
do better, but we watch the child anxiously whose wet- 
nurse is a chemist's pipkin. A pair of substantial 
mammary glands has the advantage over the two hem- 
ispheres of the most learned Professor's brain, in the 
art of compounding a nutritious fluid for infants. 

The bedside is always the true centre of medical 
teaching. Certain branches must be taught in the 
lecture-room, and will necessarily involve a good deal 
that is not directly useful to the future practitioner. 
But the over ambitious and active student must not be 
led away by the seduction of knowledge for its own 
sake from his principal pursuit. The humble beginner, 
who is alarmed at the vast fields of knowledge opened 
to him, may be encouraged by the assurance that with 
a very slender provision of science, in distinction from 
practical skill, he may be a useful and acceptable mem- 
ber of the profession to which the health of the com- 
munity is intrusted. 

To those who are not to engage in practice, the vari- 
ous pursuits of science hardly require to be commended. 
Only they must not be disappointed if they find many 
subjects treated in our courses as a medical class re- 
quires, rather than as a scientific class would expect, 
that is, with special limitations and constant reference 
to practical ends. Fortunately they are within easy 
reach of the highest scientific instruction. The busi- 
ness of a school like this is to make useful working 
physicians, and to succeed in this it is almost as im- 
portant not to overcrowd the mind of the pupil with 
merely curious knowledge as it is to store it with use* 
ful information. 



SCHOLASTIC AND BEDSIDE TEACHING. 277 

In this direction I have written my lecture, not to 
undervalue any form of scientific labor in its place, — 
an unworthy thought from which I hope I need not 
defend myself, — but to discourage any undue infla- 
tion of the scholastic programme, which even now 
asks more of the student than the teacher is able to 
obtain from the great majority of those who present 
themselves for examination, I wish to take a hint in 
education from the Secretary of the Massachusetts 
Board of Agriculture, who regards the cultivation of 
too much land as a great defect in our New England 
farming. I hope that our Medical Institutions may 
never lay themselves open to the kind of accusation 
Mr. Lowe brings against the English Universities, 
when he says that their education is made up "of words 
that few understand and most will shortly forget ; of 
arts that can never be used, if indeed they can even be 
learnt ; of histories inapplicable to our times ; of lan- 
guages dead, and even mouldy; of grammatical rides 
that never had living use and are only post mortem 
examinations ; and of statements fagoted with utter 
disregard of their comparative value." 

This general thought will be kept in view through- 
out my somewhat discursive address, which will begin 
with an imaginary clinical lesson from the lips of an 
historical personage, and close with the portrait from 
real life of one who, both as teacher and practitioner, 
was long loved and honored among us. If I somewhat 
overrun my hour, you must pardon me, for I can say 
with Pascal that I have not had the time to make my 
lecture shorter. 

In the year 1647, that good man John Eliot, com- 
monly called the Apostle Eliot, writing to Mr. Thomas 



278 MEDICAL ESSAYS. 

Shepherd, the pious minister of Cambridge, referring 
to the great need of medical instruction for the Indians, 
used these words : — 

" I have thought in my heart that ifc were a singular 
good work, if the Lord would stirre up the hearts of 
some or other of his people in England to give some 
maintenance toward some Schoole or Collegiate exer- 
cise this way, wherein there should be Anatomies and 
other instructions that way, and where there might be 
some recompence given to any that should bring in any 
vegetable or other thing that is vertuous in the way 
of Physick. 

" There is another reason which moves my thought 
and desires this way, namely that our young students 
in Physick may be trained up better then they yet bee, 
who have onely theoreticall knowledge, and arc forced 
to fall to practise before ever they saw an Anatomy 
made, or duely trained up in making experiments, for 
we never had but one Anatomy in the countrey, which 
Mr. Giles Firman [Firmin] now in England, did make 
and read upon very well, but no more of that now." 

Since the time of the Apostle Eliot the Lord has 
stirred up the hearts of our people to the building of 
many Schools and Colleges where medicine is taught 
in all its branches. Mr. Giles Firmin' s " Anatomy " 
may be considered the first ancestor of a long line of 
skeletons which have been dangling and rattling in 
our lecture-rooms for more than a century. 

Teaching in New England in 1G4T was a grave but 
simple matter. A single person, combining in many 
cases, as in that of Mr. Giles Firmin, the offices of 
physician and preacher, taught what he knew to a few 
disciples whom lie gathered about him. Of the making 
of that " Anatomy " on which my first predecessor in 



SCHOLASTIC AND BEDSIDE TEACHING. 279 

the branch I teach " did read very well " we can know 
nothing. The body of some poor wretch who had 
swung upon the gallows, was probably conveyed by 
night to some lonely dwelling at the outskirts of the 
village, and there by the light of flaring torches hastily 
dissected by hands that trembled over the unwonted 
task. And ever and anon the master turned to his 
book, as he laid bare the mysteries of the hidden or- 
gans ; to his precious Vesalius, it might be, or his fig- 
ures repeated in the multifarious volume of Ambroise 
Pare ; to the Aldine octavo in which Fallopius recorded 
his fresh observations ; or that giant folio of Spigelius 
just issued from the press of Amsterdam, in which 
lovely ladies display their viscera with a coquettish 
grace implying that it is rather a pleasure than other- 
wise to show the lace-like omentum, and hold up their 
appendices epiploicae as if they were saying " these are 
our jewels." 

His teaching of medicine was no doubt chiefly clin- 
ical, and received with the same kind of faith as that 
which accepted his words from the pulpit. His notions 
of disease were based on what he had observed, seen 
always in the light of the traditional doctrines in which 
he was bred. His discourse savored of the weighty 
doctrines of Hippocrates, diluted by the subtle specu- 
lations of Galen, reinforced by the curious comments 
of the Arabian schoolmen as they were conveyed in the 
mellifluous language of Fernelius, blended, it may be, 
with something of the lofty mysticism of Van Helmont, 
and perhaps stealing a flavor of that earlier form of 
Homoeopathy which had lately come to light in Sir 
Kenelm Digby's "Discourse concerning the Cure of 
Wounds by the Sympathetic Powder." 

His Pathology was mythology. A malformed foetus, 



280 MEDICAL ESSAYS. 

as the readers of Winthrop's Journal may remember, 
was enough to scare the colonists from their propriety, 
and suggest the gravest fears of portended disaster. 
The student of the seventeenth century opened his 
Licetus and saw figures of a lion with the head of a 
woman, and a man with the head of an elephant. He 
had offered to his gaze, as born of a human mother, the 
effigy of a winged cherub, a pterocephalous specimen, 
which our Professor of Pathological Anatomy would 
hardly know whether to treat with the reverence due 
to its celestial aspect, or to imprison in one of his im- 
mortalizing jars of alcohol. 

His pharmacopoeia consisted mainly of simples, such 
as the venerable " Herball " of Gerard describes and 
figures in abounding affluence. St. John's wort and 
Clown's All-heal, with Spurge and Fennel, Saffron and 
Parsley, Elder and Snake-root, with opium in some 
form, and roasted rhubarb and the Four Great Cold 
Seeds, and the two Resins, of which it used to be said 
that whatever the Taeamahaea has not cured, the Car- 
anna will, with the more familiar Seammony and Jalap 
and Black Hellebore, made up a good part of his prob- 
able list of remedies. He would have ordered Iron 
now and then, and possibly an occasional dose of An- 
timony. He would perhaps have had a rheumatic 
patient wrapped in the skin of a wolf or a wild cat, 
and in case of a malignant fever with "purples" or 
petechia?, or of an obstinate king's evil, he might have 
prescribed a certain black powder, which had been 
made by calcining toads in an earthen pot ; a choice 
remedy, taken internally, or applied to any outward 
grief. 

Except for the toad-powder and the peremptory 
drastics, one might have borne up against this herb- 



SCHOLASTIC AND BEDSIDE TEACHING. 281 

doctoring as well as against some more modern styles 
of medication. Barbeyrac and Ins scholar Sydenham 
had not yet cleansed the Pharmacopoeia of its perilous 
stuff, but there is no doubt that the more sensible phy- 
sicians of that day knew well enough that a good hon- 
est herb-tea which amused the patient and his nurses 
was all that was required to carry him through all com- 
mon disorders. 

The student soon learned the physiognomy of disease 
by going about with his master ; fevers, pleurisies, 
asthmas, dropsies, fluxes, small-pox, sore-throats, mea- 
sles, consumptions. He saw what was done for them. 
He put up the medicines, gathered the herbs, and so 
learned something of materia medica and botany. He 
learned these few things easily and well, for he could 
give his whole attention to them. Chirurgery was a 
separate specialty. Women in child-birth were cared 
for by midwives. There was no chemistry deserving 
the name to require his study. He did not learn a 
great deal, perhaps, but what he did learn was his 
business, namely, how to take care of sick people. 

Let me give you a picture of the old-fashioned way 
of instruction, by carrying you with me in imagination 
in the company of worthy Master Giles Firmin as he 
makes his round of visits among the good folk of Ips- 
wich, followed by his one student, who shall answer to 
the scriptural name of Luke. It will not be for enter- 
tainment chiefly, but to illustrate the one mode of 
teaching which can never be superseded, and which, I 
venture to say, is more important than all the rest put 
together. The student is a green hand, as you will 
perceive. 

In the first dwelling they come to, a stout fellow is 
bellowing with colic. 



282 MEDICAL ESSAYS. 

" He will die, Master, of a surety, methinks," says 
the timid youth in a whisper. 

"Nay, Luke," the Master answers, "'tis but a dry 
belly-ache. Didst thou not mark that he stayed his 
roaring when I did press hard over the lesser bowels ? 
Note that he hath not the pulse of them with fevers, 
and by what Dorcas telleth me there hath been no long 
shutting up of the vice naturales. We will steep cer- 
tain comforting herbs which I will shew thee, and put 
them in a bag and lay them on his belly. Likewise he 
shall have my cordial julep with a portion of this con- 
fection which we do call Theriaca Andromachi, which 
hath juice of poppy in it, and is a great stayer of an- 
guish. This fellow is at his prayers to-day, but I war- 
rant thee he shall be swearing with the best of them 
to-morrow." 

They jog along the bridle-path on their horses until 
they come to another lowly dwelling. They sit a while 
with a delicate looking girl in whom the ingenuous 
youth naturally takes a special interest. The good 
physician talks cheerfully with her, asks her a few 
questions. Then to her mother : " Good-wife, Mar- 
garet hath somewhat profited, as she telleth, by the 
goat's milk she hath taken night and morning. Do 
thou pluck a maniple — that is an handful — of the 
plant called Maidenhair, and make a syrup therewith 
as I have shewed thee. Let her take a cup full of the 
same, fasting, before she sleepeth, also before she riseth 
from her bed." And so they leave the house. 

" What thinkest thou, Luke, of the maid we have 
been visiting ? " " She seemeth not much ailing, 
Master, according to my poor judgment. For she did 
say she was better. And she had a red cheek and a 
bright eye, and she spake of being soon able to walk 



SCHOLASTIC AND BEDSIDE TEACHING. 283 

unto the meeting, and did seem greatly hopeful, but 
spare of flesh, methought, and her voice something 
hoarse, as of one that hath a defluxion, with some small 
coughing from a cold, as she did say. Speak I not 
truly, Master, that she will be well speedily ? " 

" Yea, Luke, I do think she shall be well, and may- 
hap speedily. But it is not here with us she shall be 
well. For that redness of the cheek is but the sign of 
the fever which, after the Grecians, we do call the hec- 
tical ; and that shining of the eyes is but a sickly 
glazing, and they which do every day get better and 
likewise thinner and weaker shall find that way lead- 
eth to the church-yard gate. This is the malady which 
the ancients* did call tabes, or the wasting disease, and 
some do name the consumption. A disease whereof 
most that fall ailing do perish. This Margaret is 
not long for earth — but she knoweth it not, and still 
hopeth." 

"Why, then, Master, didst thou give her of thy 
medicine, seeing that her ail is unto death ? " 

" Thou shalt learn, boy, that they which are sick 
must have somewhat wherewith to busy their thoughts. 
There be some who do give these tabid or consumptives 
a certain posset made with lime-water and anise and 
liquorice and raisins of the sun, and there be other 
some who do give the juice of craw-fishes boiled in bar- 
ley-water with chicken-broth, but these be toys, as I do 
think, and ye shall find as good virtue, nay better, in 
this syrup of the simple called Maidenhair." 

Something after this manner might Master Giles 
Firinin have delivered his clinical instructions. Some- 
what in this way, a century and a half later, another 
New England physician, Dr. Edward Augustus Hol- 
yoke, taught a young man who came to study with him, 



284 MEDICAL ESSAYS. 

a very diligent and intelligent youth, James Jackson by 
name, the same whose portrait in his advanced years 
hangs upon this wall, long the honored Professor of 
Theory and Practice in this Institution, of whom I 
shall say something in this Lecture. Our venerated 
Teacher studied assiduously afterwards in the great 
London Hospitals, but I think he used to quote his " old 
Master " ten times where he quoted Mr. Cline or Dr. 
Woodville once. 

When I compare this direct transfer of the prac- 
tical experience of a wise man into the mind of a stu- 
dent, — every fact one that he can use in the battle of 
life and death, — with the far off, unserviceable " scien- 
tific " truths that I and some others are in the habit of 
teaching, I cannot help asking myself whether, if we 
concede that our forefathers taught too little, there is 
not a possibility that we may sometimes attempt to 
teach too much. I almost blush when I think of my- 
self as describing the eight several facets on two slen- 
der processes of the palate bone, or the seven little 
twigs that branch off from the minute tympanic nerve, 
and I wonder whether my excellent colleague feels in 
the same way when he pictures himself as giving the 
constitution of neurin, which as he and I know very 
well is that of the hydrate of trimethyle-oxethyle-am- 
monium, or the formula for the production of alloxan, 
which, though none but the Professors and older stu- 
dents can be expected to remember it, is C 10 H 4 N 4 O c + 
2 HO, N0 6 }=C 8 H 4 N 2 O 10 + 2 C0 2 +N,+NH 4 O, N0 5 . 

I can hear the voice of some rough iconoclast ad- 
dressing the Anatomist and the Chemist in tones of 
contemptuous indignation : " What is this stuff with 
which you are cramming the brains of young men who 
are to hold the lives of the community in their hands ? 



SCHOLASTIC AND BEDSIDE TEACHING. 285 

Here is a man fallen in a fit ; you can tell me all about 
the eight surfaces of the two processes of the palate- 
bone, but you have not had the sense to loosen that 
man's neck-cloth, and the old women are all calling 
you a fool ? Here is a fellow that has just swallowed 
poison. I want something to turn his stomach inside 
out at the shortest notice. Oh, you have forgotten the 
dose of the sulphate of zinc, but you remember the for- 
mula for the production of alloxan ! " 

"Look you, Master Doctor, — if I go to a carpenter 
to come and stop a leak in my roof that is flooding the 
house, do you suppose I care whether he is a botanist 
or not ? Cannot a man work in wood without knowing 
all about endogens and exogens, or must he attend 
Professor Gray's Lectures before he can be trusted to 
make a box-trap ? If my horse casts a shoe, do you 
think I will not trust a blacksmith to shoe him until I 
have made sure that he is sound on the distinction be- 
tween the sesquioxide and the protosesquioxide o£ 
iron?" 

— But my scientific labor is to lead to useful results 
by and by, in the next generation, or in some possible 
remote future. — 

" Diavolo ! " as your Dr. Rabelais has it, — answers 
the iconoclast, — " what is that to me and my colic, to 
me and my strangury? I pay the Captain of the 
Cunard steamship to carry me quickly and safely to 
Liverpool, not to make a chart of the Atlantic for after 
voyagers ! If Professor Peirce undertakes to pilot me 
into Boston Harbor and runs me on Cohasset rocks, 
what answer is it to tell me that he is Superintendent 
of the Coast Survey ? No, Sir ! I want a plain man 
in a pea-jacket and a sou'wester, who knows the chan- 
nel of Boston Harbor, and the rocks of Boston Harbor 9 



286 MEDICAL ESSAYS. 

and the distinguished Professor is quite of my mind as 
to the matter, for I took the pains to ask him before I 
ventured to use his name in the way of illustration." 

I do not know how the remarks of the imasre- 
breaker may strike others, but I feel that they put me 
on my defence with regard to much of my teaching. 
Some years ago I ventured to show in an introductory 
Lecture how very small a proportion of the anatomical 
facts taught in a regular course, as delivered by myself 
and others, had any practical bearing whatever on the 
treatment of disease. How can I, how can any medi- 
cal teacher justify himself in teaching anything that is 
not like to be of practical use to a class of young men 
who are to hold in their hands the balance in which 
life and death, ease and anguish, happiness and wretch- 
edness are to be daily weighed ? 

I hope we are not all wrong. Oftentimes in finding 
how sadly ignorant of really essential and vital facts 
and rules were some of those whom we had been Lad- 
ing with the choicest scraps of science, I have doubted 
whether the old one-man system of teaching, when the 
one man was of the right sort, did not turn out better 
working physicians than our more elaborate method. 
The best practitioner I ever knew was mainly shaped 
to excellence in that way. I can understand perfectly 
the regrets of my friend Dr. John Brown of Edin- 
burgh, for the good that was lost with the old appren- 
ticeship system. I understand as well Dr. Latham's 
fear u that many men of the best abilities and good 
education will be deterred from prosecuting physic as 
a profession, in consequence of the necessity indis- 
criminately laid upon all for impossible attainments." 
I feel therefore impelled to say a very few words in 
defence of that system of teaching adopted in our Col- 



SCHOLASTIC AND BEDSIDE TEACHING. 287 

leges, by which we wish to supplement and complete 
the instruction given by private individuals or by what 
are often called Summer Schools. 

The reason why we teach so much that is not prac- 
tical and in itself useful, is because we find that the 
easiest way of teaching what is practical and useful. 
If we could in any way eliminate all that would help 
a man to deal successfully with disease, and teach it 
by itself so that it should be as tenaciously rooted in 
the memory, as easily summoned when wanted, as fer- 
tile in suggestion of related facts, as satisfactory to the 
peremptory demands of the intelligence as if taught in 
its scientific connections, I think it would be our duty 
so to teach the momentous truths of medicine, and to 
regard all useless additions as an intrusion on the time 
which should be otherwise occupied. 

But we cannot successfully eliminate and teach by 
itself that which is purely practical. The easiest and 
surest way of acquiring facts is to learn them in 
groups, in systems, and systematized knowledge is sci- 
ence. You can very often carry two facts fastened to- 
gether more easily than one by itself, as a housemaid 
can carry two pails of water with a hoop more easily 
than one without it. You can remember a man's face, 
made up of many features, better than you can his 
nose or his mouth or his eye-brow. Scores of proverbs 
show you that you can remember two lines that rhyme 
better than one without the jingle. The ancients, who 
knew the laws of memory, grouped the seven cities 
that contended for the honor of being Homer's birth- 
place in a line thus given by Aulus Gellius : — 

Smurna, Roclos, Colophon, Salamin, Ios, Argos, Athenai. 

I remember, in the earlier political days of Martin 
Van Buren, that Colonel Stone, of the "New York 



288 MEDICAL ESSAYS. 

Commercial," or one of his correspondents, said that 
six towns of New York would claim in the same way 
to have been the birth-place of the " Little Magician," 
as he was then called ; and thus he gave their names, 
any one of which I should long ago have forgotten, 
but which as a group have stuck tight in my memory 
from that day to this ; — 

Catskill, Saugerties, Reilhook, Kindurhook, Scagliticoke, Scho- 
dac. 

If the memory gains so much by mere rhythmical 
association, how much more will it gain when isolated 
facts are brought together under laws and principles, 
when organs are examined in their natural connec- 
tions, when structure is coupled with function, and 
healthy and diseased action are studied as they pass 
one into the other ! Systematic, or scientific study is 
invaluable as supplying a natural kind of mnemonics, 
if for nothing else. You cannot properly learn the 
facts you want from Anatomy and Chemist^ in any 
way so easily as by taking them in their regular order, 
with other allied facts, only there must be common 
sense exercised in leaving out a great deal which be- 
longs to each of the two branches as pure science. The 
dullest of teachers is the one who does not know what 
to omit. 

The larger aim of scientific training is to furnish 
you with principles to which you will be able to refer 
isolated facts, and so bring these within the range of 
recorded experience. See what the ; ' London Times " 
said about the three Germans who cracked open John 
Bull Chatwood's strong-box at the Fair the other day, 
while the three Englishmen hammered away in vain at 
Brother Jonathan Herring's. The Englishmen repre- 
sented brute force. The Germans had been trained to 



SCHOLASTIC AND BEDSIDE TEACHING. 289 

appreciate principle. The Englishman "knows his 
business by rote and rule of thumb " — science, which 
would " teach him to do in an hour what has hitherto 
occupied him two hours," "is in a manner forbidden 
to him." To this cause the "Times" attributes the 
falling off of English workmen in comparison with 
those of the Continent. 

Granting all this, we must not expect too much 
from " science " as distinguished from common expe- 
rience. There are ten thousand experimenters with- 
out special apparatus for every one in the laboratory. 
Accident is the great chemist and toxicologist. Battle 
is the great vivisector. Hunger has instituted re_ 
searches on food such as no Liebig, no Academic Com- 
mission has ever recorded. 

Medicine, sometimes impertinently, often ignorantly, 
often carelessly called " allopathy," appropriates every- 
thing from every source that can be of the slightest 
use to anybody who is ailing in any way, or like to be 
ailing from any cause. It learned from a monk how 
to use antimony, from a Jesuit how to cure agues, 
from a friar how to cut for stone, from a soldier how 
to treat gout, from a sailor how to keep off scurvy, 
from a postmaster how to sound the Eustachian tube, 
from a dairy-maid how to prevent small-pox, and from 
an old market-woman how to catch the itch-insect. It 
borrowed acupuncture and the moxa from the Japan- 
ese heathen, and was taught the use of lobelia by the 
American savage. It stands ready to-day to accept 
anything from any theorist, from any empiric who can 
make out a good case for his discovery or his remedy. 
" Science " is one of its benefactors, but only one, out 
of many. Ask the wisest practising physician you 
know, what branches of science help him habitually 9 

19 



290 MEDICAL ESSAYS. 

and what amount of knowledge relating to each branch 
he requires for his professional duties. He will tell 
you that scientific training has a value independent of 
all the special knowledge acquired. He will tell you 
that many facts are explained by studying them in 
the wider range of related facts to which they belong. 
He will gratefully recognize that the anatomist has 
furnished him with indispen sable data, that the physi- 
ologist has sometimes put him on the track of new 
modes of treatment, that the chemist has isolated the 
active principles of his medicines, has taught him how 
to combine them, has from time to time offered him 
new remedial agencies, and so of others of his allies. 
But he will also tell you, if I am not mistaken, that 
his own branch of knowledge is so extensive and so 
perplexing that he must accept most of his facts ready 
made at their hands. He will own to you that in the 
struggle for life which goes on day and night in our 
thoughts as in the outside world of nature, much that 
he learned under the name of science has died out, 
and that simple homely experience has largely taken 
the place of that scholastic knowledge to which he and 
perhaps some of Ins instructors once attached a para- 
mount importance. 

This, then, is my view of scientific training as con- 
ducted in courses such as you are entering on. Up to 
a certain point I believe in set Lectures as excellent 
adjuncts to what is far more important, practical in- 
struction at the bedside, in the operating room, and 
under the eye of the Demonstrator. But I am so far 
from wishing these courses extended, that I think some 
of them — suppose I say my own — would almost bear 
curtailing. Do you want me to describe more branches 
of the sciatic and crural nerves ? I can take Fischer's 



SCHOLASTIC AND BEDSIDE TEACHING. 291 

plates, and lecturing on that scale fill up my whole 
course and not finish the nerves alone. We must stop 
somewhere, and for my own part I think the scholastic 
exercises of our colleges have already claimed their 
full share of the student's time without our seeking to 
extend them. 

I trust I have vindicated the apparent inconsequence 
of teaching young students a good deal that seems at 
first sight profitless, but which helps them to learn 
and retain what is profitable. But this is an inquisi- 
tive age, and if we insist on piling up beyond a certain 
height knowledge which is in itself mere trash and 
lumber to a man whose life is to be one loii£ fioht with 
death and disease, there will be some sharp questions 
asked by and by, and our quick-witted people will per- 
haps find they can get along as well without the pro- 
fessor's cap as without the bishop's mitre and the mon- 
arch's crown. 

I myself have nothing to do with clinical teaching. 
Yet I do not hesitate to say it is more essential than 
all the rest put together, so far as the ordinary prac- 
tice of medicine is concerned ; and this is by far the 
most important thing to be learned, because it deals 
with so many more lives than any other branch of the 
profession. So of personal instruction, such as we 
give and others give in the interval of lectures, much 
of it at the bedside, some of it in the laboratory, some 
in the microscope-room, some in the recitation-room, I 
think it has many advantages of its own over the win- 
ter course, and I do not wish to see it shortened for 
the sake of prolonging what seems to me long enough 
already. 

If I am jealous of the tendency to expand the time 
given to the acquisition of curious knowledge, at the 



292 MEDICAL ESSAYS. 

expense of the plain old-fashioned bedside teachings, I 
only share the feeling which Sydenham expressed two 
hundred years ago, using an image I have already bor- 
rowed. " He would be no honest and successful pilot 
who was to apply himself with less industry to avoid 
rocks and sands and bring his vessel safely home, than 
to search into the causes of the ebbing and flowing of 
the sea, which, though very well for a philosopher, is 
foreign to him whose business it is to secure the ship. 
So neither will a physician, whose province it is to cure 
diseases, be able to do so, though he be a person of 
great genius, who bestows less time on the hidden and 
intricate method of nature, and adapting his means 
thereto, than on curious and subtle speculation." 

" Medicine is my wife and Science is my mistress," 
said Dr. Rush. I do not think that the breach of the 
seventh commandment can be shown to have been of 
advantage to the legitimate owner of Iris affections. 
Read what Dr. Elisha Bartlett says of him as a prac- 
titioner, or ask one of our own honored ex-prof cssors, 
who studied under him, whether Dr. Rush had ever 
learned the meaning of that saying of Lord Bacon, 
that man is the minister and interpreter of Nature, or 
whether he did not speak habitually of Nature as an 
intruder in the sick room, from which his art was to 
expel her as an incompetent and a meddler. 

All a man's powers are not too much for such a pro- 
fession as Medicine. " He is a learned man," said old 
Parson Emmons of Franklin, " who understands one 
subject, and he is a very learned man who understands 
two subjects." Schonbein says he has been studying 
oxygen for thirty } r ears. Mitscherlich said it took 
fourteen years to establish a new fact in chemistry. 
Aubrey says of Harvey, the discoverer of the circular 



SCHOLASTIC AND BEDSIDE TEACHING. 293 

tion, that " though all his profession would allow him 
to be an excellent anatomist, I have never heard of 
any who admired his therapeutic way." My learned 
and excellent friend before referred to, Dr. Brown of 
Edinburgh, from whose very lively and sensible Essay, 
"Locke and Sydenham," I have borrowed several of 
my citations, contrasts Sir Charles Bell, the discov- 
erer, the man of science, with Dr. Abercrombie, the 
master in the diagnosis and treatment of disease. It 
is through one of the rarest of combinations that we 
have in our Faculty a teacher on whom the scientific 
mantle of Bell has fallen, and who yet stands preemi- 
nent in the practical treatment of the class of diseases 
which his inventive and ardent experimental genius 
has illustrated. M. Brown-Sequard's example is as 
eloquent as his teaching in proof of the advantages of 
well directed scientific investigation. But those who 
emulate his success at once as a discoverer and a prac- 
titioner must be content like him to limit their field 
of practice. The highest genius cannot afford in our 
time to forget the ancient precept, Divide et imp era. 

" I suppose I must go and earn this guinea," 

said a medical man who was sent for while he was dis- 
secting an animal. I should not have cared to be his 
patient. His dissection would do me no good, and his 
thoughts would be too much upon it. I want a whole 
man for my doctor, not a half one. I would have sent 
for a humbler practitioner, who would have given him- 
self entirely to me, and told the other — who was no 
less a man than John Hunter — to go on and finish 
the dissection of his tiger. 

Sydenham's " Read Don Quixote " should be ad- 
dressed not to the student, but to the Professor of to- 
day. Aimed at him it means, " Do not be too learned. 



294 MEDICAL ESSAYS. 

Do not think yon are going to lecture to picked young 
men wlio are training themselves to be scientific dis- 
coverers. They are of fair average capacity, and they 
are going to be working doctors.'* 

These young men are to have some very serious 
vital facts to deal with. I will mention a few of them. 

Every other resident adult you meet in these streets 
is or will be more or less tuberculous. This is not an 
extravagant estimate, as very nearly one third of the 
deaths of adults in Boston last year were from phthi- 
sis. If the relative number is less in our other north- 
ern cities, it is probably in a great measure because 
they are more unhealthy ; that is, they have as much, 
or nearly as much, consumption, but they have more 
fevers or other fatal diseases. 

These heavy-eyed men with the alcoholized brains, 
these pallid youths with the nicotized optic ganglia and 
thinking-marrows brown as their own meerschaums, — ■ 
of whom you meet too many, — will ask all your wis- 
dom to deal with their poisoned nerves and their en- 
feebled wills. 

Nearly seventeen hundred children under five years 
of age died last year in this city. A poor human arti- 
cle, no doubt, in many cases, still, worth an attempt to 
save them, especially when we remember the effect of 
Dr. Clarke's suggestion at the Dublin Hospital, by 
which some twenty-five or thirty thousand children's 
lives have probably been saved in a single city. 

Again, the complaint is often heard that the native 
population is not increasing so rapidly as in former 
generations. The breeding and nursing period of 

• Total number of deaths, 4379; under 20 years, 2109; over 
20 years, 2270. From phthisis, 84.6; under 20 years, 146; over 
20 years, 700. 



SCHOLASTIC AND BEDSIDE TEACHING. 295 

American women is one of peculiar delicacy and fre- 
quent infirmity. Many of them must require a con- 
siderable interval between the reproductive efforts, to 
repair damages and regain strength. This matter is 
not to be decided by an appeal to unschooled nature. 
It is the same question as that of the deformed pelvis, 
— one of degree. The facts of mal-vitalization are as 
much to be attended to as those of mal-formation. If 
the woman with a twisted pelvis is to be considered 
an exempt, the woman with a defective organization 
should be recognized as belonging to the invalid corps. 
We shudder to hear what is alleged as to the preva- 
lence of criminal practices ; if back of these there can 
be shown organic incapacity or overtaxing of too lim- 
ited powers, the facts belong to the province of the 
practical physician, as well as of the moralist and the 
legislator, and require his gravest consideration. 

Take the important question of bleeding. Is vene- 
section done with forever ? Six years ago it was said 
here in an introductory Lecture that it would doubt- 
less come back again sooner or later. A fortnight ago 
I found myself in the cars with one of the most sensi- 
ble and esteemed practitioners in New England. He 
took out his wallet and showed me two lancets, which 
he carried with him ; he had never given up their use. 
This is a point you will have to consider. 

Or, to mention one out of many questionable reme- 
dies, shall you give Veratrum Viride in fevers and in- 
flammations ? It makes the pulse slower in these af- 
fections. Then the presumption would naturally be 
that it does harm. The caution with reference to it 
on this ground was long ago recorded in the Lecture 
above referred to. See what Dr. John Hughes Ben- 
nett says of it in the recent edition of his work on 



296 MEDICAL ESSAYS. 

Medicine. Nothing but the most careful clinical ex- 
perience can settle this and such points of treatment. 

These are all practical questions — questions of life 
and death, and every day will be full of just such 
questions. Take the problem of climate. A patient 
comes to you with asthma and wants to know where he 
can breathe ; another comes to you with phthisis and 
wants to know where he can live. What boy's play 
is nine tenths of all that is taught in many a preten- 
tious course of lectures, compared with what an accu- 
rate and extensive knowledge of the advantages and 
disadvantages of different residences in these and 
other complaints would be to a practising physician ! 
I saw the other day a gentleman living in Canada, who 
had spent seven successive winters in Egypt, with the 
entire relief of certain obscure thoracic symptoms 
which troubled him while at home. I saw, two months 
ago, another gentleman from Minnesota, an observer 
and a man of sense, who considered that State as the 
great sanatorium for all pulmonary complaints. If 
half our grown population are or will be more or less 
tuberculous, the question of colonizing Florida assumes 
a new aspect. Even within the borders of our own 
State, the very interesting researches of Dr. Bowditch 
show that there is a great variation in the amount of 
tuberculous disease in different towns, apparently con- 
nected with local conditions. The hygienic map of a 
State is quite as valuable as its geological ma]), and it 
is the business of every practising physician to know 
it thoroughly. They understand this in England, and 
send a patient with a dry irritating cough to Torquay 
or Penzance, while they send another with relaxed 
bronchial membranes to Clifton or Brighton. Here is 
another great field for practical study. 



SCHOLASTIC AND BEDSIDE TEACHING. 297 

So as to the all-important question of diet. " Of all 
the means of cure at our command," says Dr. Bennett, 
" a regulation of the quantity and quality of the diet 
is by far the most powerful." Dr. MacCormac would 
perhaps except the air we breathe, for he thinks that 
impure air, especially in sleeping rooms, is the great 
cause of tubercle. It is sufficiently proved that the 
American, — the New Englander, — the Bostonian, — 
can breed strong and sound children, generation after 
generation, — nay, I have shown by the record of a 
particidar family that vital losses may be retrieved, 
and a feeble race grow to lusty vigor in this very cli- 
mate and locality. Is not the question why our young 
men and women so often break down, and how they 
can be kept from breaking down, far more important 
for physicians to settle than whether there is one 
cranial vertebra, or whether there are four, or none ? 

— But I have a taste for the homologies, I want to 
go deeply into the subject of embryology, I want to 
analyze the protonihilates precipitated from pigeon's 
milk by the action of the lunar spectrum, — shall I not 
follow my star, — shall I not obey my instinct, — shall 
I not give myself to the lofty pursuits of science for 
its own sake ? — 

Certainly you may, if you like. But take down 
your sign, or never put it up. That is the way Dr. 
Owen and Dr. Huxley, Dr. Agassiz and Dr. Jeffries 
Wyman, Dr. Gray and Dr. Charles T. Jackson settled 
the difficulty. We all admire the achievements of 
this band of distinguished doctors who do not practise. 
But we say of their work and of all pure science, as 
the French officer said of the charge of the six hundred 
at Balaclava, " C'est magnifique, mais ce riest pas la 
guerre" — it is very splendid, but it is not a practising 



298 MEDICAL ESSAYS. 

doctor's business. His patient has a right to the 
cream of his life and not merely to the thin milk that 
is left after " science " has skimmed it off. The best 
a physician can give is never too good for the patient. 

It is often a disadvantage to a young practitioner to 
be known for any accomplishment outside of his pro«= 
fession. Haller lost his election as Physician to the 
Hospital in his native city of Berne, principally on the 
ground that he was a poet. In his later years the phy- 
sician may venture more boldly. Astruc was sixty- 
nine years old when he published his " Conjectures," 
the first attempt, we are told, to decide the authorship 
of the Pentateuch showing anything like a discerning 
criticism. Sir Benjamin Brodie was seventy years old 
before he left his physiological and surgical studies to 
indulge in psychological speculations. The period of 
pupilage will be busy enough in acquiring the knowl- 
edge needed, and the season of active practice will 
leave little leisure for any but professional studies. 

Dr. Graves of Dublin, one of the first clinical teach- 
ers of our time, always insisted on his students' begin- 
ning at once to visit the hospital. At the bedside the 
student must learn to treat disease, and just as cer- 
tainly as we spin out and multiply our academic pre- 
lections we shall work in more and more stuffing, more 
and more rubbish, more and more irrelevant, useless 
detail which the student will get rid of just as soon as 
he leaves us. Then the next thing will be a new or- 
ganization, with an examining board of first-rate prac- 
tical men, who will ask the candidate questions that 
mean business, — who will make him operate if he is to 
be a surgeon, and try him at the bedside if he is to 
be a physician, — and not puzzle him with scientific 
conundrums which not more than one of the question* 



SCHOLASTIC AND BEDSIDE TEACHING. 299 

ers could answer himself or ever heard of since he 
graduated. 

Or these women who are hammering at the gates on 
which is written " No admittance for the mothers of 
mankind," will by and by organize an institution, 
which starting from that skilful kind of nursing which 
Florence Nightingale taught so well, will work back- 
wards through anodynes, palliatives, curatives, preven- 
tives, until with little show of science it imparts most 
of what is most valuable in those branches of the heal- 
ing art it professes to teach. When that time comes, 
the fitness of women for certain medical duties, which 
Hecquet advocated in 1708, which Douglas maintained 
in 1736, which Dr. John Ware, long the honored Pro- 
fessor of Theory and Practice in this Institution, up- 
held within our own recollection in the face of his own 
recorded opinion to the contrary, will very possibly h& 
recognized. 

My advice to every teacher less experienced than 
myself would be, therefore : Do not fret over the de- 
tails you have to omit ; you probably teach altogether 
too many as it is. Individuals may learn a thing with 
once hearing it, but the only way of teaching a whole 
class is by enormous repetition, representation, and il- 
lustration in all possible forms. Now and then you 
will have a young man on your benches like the late 
Waldo Burnett, — not very often, if you lecture half 
a century. You cannot pretend to lecture chiefly for 
men like that, — a Mississippi raft might as well 
take an ocean-steamer in tow. To meet his wants 
you would have to leave the rest of your class behind, 
and that you must not do. President Allen of Jeffer- 
son College says that his instruction has been success- 
ful in proportion as it has been elementary. It may 



300 MEDICAL ESSAYS. 

be a humiliating statement, but it is one which I have 
found true in my own experience. 

To the student I would say, that however plain and 
simple may be our teaching, he must expect to forget 
much which he follows intelligently in the lecture-room. 
But it is not the same as if he had never learned it. 
A man must get a thing before he can forget it. 
There is a great world of ideas we cannot voluntarily 
recall, — they are outside the limits of the will. But 
they sway our conscious thought as the unseen planets 
influence the movements of those within the sphere of 
vision. No man knows how much he knows, — how 
many ideas he has, — any more than he knows how 
many blood-globules roll in his veins. Sometimes ac- 
cident brings back here and there one, but the mind 
is full of irrevocable remembrances and unthinkable 
thoughts, which take a part in all its judgments as in- 
destructible forces. Some of you must feel your scien- 
tific deficiencies painfully after your best efforts. But 
every one can acquire what is most essential. A man 
of very moderate ability may be a good physician, if 
he devotes himself faithfully to the work. More than 
this, a positively dull man, in the ordinary acceptation 
of the term, sometimes makes a safer practitioner than 
one who has, we will say, five per cent, more brains 
than his average neighbor, but who thinks it is fifty 
per cent. more. Skulls belonging to this last variety 
of the human race are more common, I may remark, 
than specimens like the Neanderthal cranium, a cast 
of which you will find on the table in the Museum. 

Whether the average talent be high or low, the Col- 
leges of the land must make the best commodity they 
can out of such material as the country and the cities 
furnish them. The community must have Doctors as 



SCHOLASTIC AND BEDSIDE TEACHING. 301 

it must have bread. It uses up its Doctors just as it 
wears out its shoes, and requires new ones. All the 
bread need not be French rolls, all the shoes need not 
be patent leather ones ; but the bread must be some- 
thing that can be eaten, and the shoes must be some- 
thing that can be worn. Life must somehow find food 
for the two forces that rub everything to pieces, or 
burn it to ashes, — friction and oxygen. Doctors are 
oxydable products, and the schools must keep furnish- 
ing new ones as the old ones turn into oxyds ; some 
of first-rate quality that burn with a great light, — 
some of a lower grade of brilliancy, some honestly, 
unmistakably, by the grace of God, of moderate gifts, 
or in simpler phrase, dull. 

The public will give every honest and reasonably, 
competent worker in the healing art a hearty welcome. 
It is on the whole very loyal to the Medical Profes- 
sion. Three successive years have borne witness to the 
feeling with which this Institution, representing it in its 
educational aspect, is regarded by those who are them- 
selves most honored and esteemed. The great Master 
of Natural Science bade the last year's class farewell 
in our behalf, in those accents which delight every 
audience. The Head of our ancient University hon- 
ored us in the same way in the preceding season. And 
how can we forget that other occasion when the Chief 
Magistrate of the Commonwealth, that noble citizen 
whom we have just lost, large-souled, sweet-natured, 
always ready for every kind office, came among us at 
our bidding, and talked to us of our duties in words as 
full of wisdom as his heart was of goodness ? 

You have not much to fear, I think, from the fancy 
practitioners. The vulgar quackeries drop off, atro- 
phied, one after another. Homoeopathy has long been 



302 MEDICAL ESSAYS. 

encysted, and is carried on the body medical as quietly 
as an old wen. Every year gives you a more reason- 
ing and reasonable people to deal with. See how it is 
in Literature. The dynasty of British dogmatists, 
after lasting a hundred years and more, is on its last 
legs. Thomas Carlyle, third in the line of descent, 
finds an audience very different from those which lis- 
tened to the silver speech of Samuel Taylor Coleridge 
and the sonorous phrases of Samuel Johnson. We 
read him, we smile at his clotted English, his " swann- 
ery " and other picturesque expressions, but we lay 
down his tirade as we do one of Dr. Ciunmimr's inter- 
pretations of prophecy, which tells us that the world is 
coming to an end next week or next month, if the 
weather permits, — not otherwise, — feeling very sure 
that the weather will be unfavorable. 

It is the same common-sense public you will appeal 
to. The less pretension 3011 make, the belter they will 
like you in the long run. I hope we shall make every- 
thing as plain and as simple to you as we can. I 
woidd never use a lono- word, even, where a short one 
would answer the purpose. I know there are profess- 
ors in this country who "ligate" arteries. Other 
surgeons only tie them, and it stops the bleeding just 
as well. It is the familiarity and simplicity of bed- 
side instruction which makes it so pleasant as well as 
so profitable. A good clinical teacher is himself a 
Medical School. We need not wonder that our young 
men are beginning to announce themselves not only as 
graduates of this or that College, but also as pupils of 
some one distinguished master. 

I wish to close this Lecture, if you will allow me 
a few moments longer, with a brief sketch of an in- 
structor and practitioner whose character was as nearly 



SCHOLASTIC AND BEDSIDE TEACHING. 303 

a model one in both capacities as I can find anywhere 
recorded. 

Dr. James Jackson, Professor of the Theory and 
Practice of Medicine in this University from 1812 to 
1846, and whose name has been since retained on our 
rolls as Professor Emeritus, died on the 27th of August 
last, in the ninetieth year of his age. He studied his 
profession, as I have already mentioned, with Dr. Hol- 
yoke of Salem, one of the few physicians who have 
borne witness to their knowledge of the laws of life 
by living to complete their hundredth year. I think 
the student took his Old Master, as he always loved 
to call him, as his model ; each was worthy of the 
other, and both were bright examples to all who come 
after them. 

I remember that in the sermon preached by Dr. 
Brazer after Dr. Holyoke's death, one of the points 
most insisted upon as characteristic of that wise and 
good old man was the perfect balance of all his facul- 
ties. The same harmonious adjustment of powers, the 
same symmetrical arrangement of life, the same com- 
plete fulfilment of every day's duties, without haste 
and without needless delay, which characterized the 
master, equally distinguished the scholar. A glance at 
the life of our own Old Master, if I can do any justice 
at all to his excellences, will give you something to 
carry away from this hour's meeting not unworthy to 
be remembered. 

From December, 1797, to October, 1799, he remained 
with Dr. Holyoke as a student, a period which he has 
spoken of as a most interesting and most gratifying 
part of his life. After this he passed eight months in 
London, and on his return, in October, 1800, he began 
business in Boston. 



304 MEDICAL ESSAYS. 

He had followed Mr. Cline, as I have mentioned, 
and was competent to practise Surgery. But he found 
Dr. John Collins Warren had already occupied the 
ground which at that day hardly called for more than 
one leading practitioner, and wisely chose the Medical 
branch of the profession. He had only himself to rely 
upon, but he had confidence in his prospects, conscious, 
doubtless, of his own powers, knowing his own industry 
and determination, and being of an eminently cheerful 
and hopeful disposition. No better proof of his spirit 
can be given than that, just a year from the time when 
he began to practise as a physician, he took that event- 
ful step which in such a man implies that he sees his 
way clear to a position ; he married a lady blessed with 
many gifts, but not bringing him a fortune to paralyze 
his industry. 

He had not miscalculated his chances in life. He 
very soon rose into a good practice, and began the 
founding of that reputation which grew with his years, 
until he stood by general consent at the head of his 
chosen branch of the profession, to say the least, in 
this city and in all this region of country. His skill 
and wisdom were the last tribunal to which the sick 
and suffering could appeal. The community trusted 
and loved him, the profession recognized him as the 
noblest type of the physician. The young men whom 
he had taught wandered through foreign hospitals, 
where they learned many things that were valuable, 
and many that were curious ; but as they grew older 
and began to think more of their ability to help the 
sick than their power of talking about phenomena, 
they began to look back to the teaching of Dr. Jack- 
son, as he, after his London experience, looked back 
to that of Dr. Holyoke. And so it came to be at last 



SCHOLASTIC AND BEDSIDE TEACHING. 305 

that the bare mention of his name in any of our medi- 
cal assemblies would call forth such a tribute of affec- 
tionate regard as is only yielded to age when it brings 
with it the record of a life spent in well doing. 

No accident ever carries a man to eminence such as 
his in the medical profession. He who looks for it 
must want it earnestly and work for it vigorously ; 
Nature must have qualified him in many ways, and 
education must have equipped him with various knowl- 
edge, or his reputation will evaporate before it reaches 
the noon-day blaze of fame. How did Dr. Jackson 
gain the position which all conceded to him? In the 
answer to this question some among you may find a 
key that shall unlock the gate opening on that fair 
field of the future of which all dream but which not 
all will ever reach. 

First of all, he truly loved his profession. He had 
no intellectual ambitions outside of it, literary, scien- 
tific or political. To him it was occupation enough to 
apply at the bedside the best of all that he knew for 
the good of his patient ; to protect the community 
against the inroads of pestilence ; to teach the young 
all that he himself had been taught, with all that his 
own experience had added ; to leave on record some 
of the most important results of his long observation. 

With his patients he was so perfect at all points 
that it is hard to overpraise him. I have seen many 
noted British and French and American practitioners, 
but I never saw the man so altogether admirable at 
the bedside of the sick as Dr. James Jackson. His 
smile was itself a remedy better than the potable gold 
and the dissolved pearls that comforted the prsecordia 
of mediaeval monarchs. Did a patient, alarmed with- 
out cause, need encouragement, it carried the sunshine 

20 



306 MEDICAL ESSAYS. 

of hope into his heart and put all his whims to flight, 
as David's harp cleared the haunted chamber of the 
sullen king. Had the hour come, not for encourage- 
ment, but for sympathy, his face, his voice, his manner 
all showed it, because his heart felt it. So gentle was 
he, so thoughtful, so calm, so absorbed in the case be- 
fore him, not to turn round and look for a tribute to 
his sagacity, not to bolster himself in a favorite theory, 
but to find out all he could, and to weigh gravely and 
cautiously all that he found, that to follow him in his 
morning visit was not only to take a lesson in the heal- 
ing art, it was learning how to learn, how to move, 
how to look, how to feel, if that can be learned. To 
visit with Dr. Jackson was a medical education. 

He was very firm, with all his kindness. Pie would 
have the truth about his patients. The nurses found 
it out; and the shrewder ones never ventured to tell 
him anything but a straight story. A clinical dialogue 
between Dr. Jackson and Miss Kebecca Taylor, some- 
time nurse in the Massachusetts General Hospital, a 
mistress in her calling, was as good questioning and 
answering as one would be like to hear outside of the 
court-room. 

Of his practice you can form an opinion from his 
book called " Letters to a Young Physician." Like 
all sensible men from the days of Hippocrates to the 
present, he knew that diet and regimen were more im- 
portant than any drug or than all drugs put together. 
Witness bis treatment of phthisis and of epilepsy. He 
retained, however, more confidence in some remedial 
agents than most of the younger generation would con- 
cede to them. Yet his materia medica was a simple 
one. 

" When I first went to live with Dr. Holyoke," he 



SCHOLASTIC AND BEDSIDE TEACHING. 307 

says, "in 1797, showing me his shop, he said, 'There 
seems to you to be a great variety of medicines here, 
and that it will take you long to get acquainted with 
them, but most of them are unimportant. There are 
four which are equal to all the rest, namely, Mercury, 
Antimony, Bark and Opium.' ' And Dr. Jackson 
adds, " I can only say of his practice, the longer I 
have lived, I have thought better and better of it." 
When he thought it necessary to give medicine, he 
gave it in earnest. He hated half -practice — giving a 
little of this or that, so as to be able to say that one 
had done something, in case a consultation was held, 
or a still more ominous event occurred. He would 
give opium, for instance, as boldly as the late Dr. 
Fisher of Beverly, but he followed the aphorism of the 
Father of Medicine, and kept extreme remedies for 
extreme cases. 

When it came to the " non-naturals," as he would 
sometimes call them, after the old physicians, — name- 
ly, air, meat and drink, sleep and watching, motion 
and rest, the retentions and excretions, and the affec- 
tions of the mind, — he was, as I have said, of the 
school of sensible practitioners, in distinction from 
that vast community of quacks, with or without the 
diploma, who think the chief end of man is to support 
apothecaries, and are never easy until they can get 
every patient upon a regular course of something nasty 
or noxious. Nobody was so precise in his directions 
about diet, air, and exercise, as Dr. Jackson. He had 
the same dislike to the a pea pres, the about so much, 
about so often, about so long, which I afterwards 
found among the punctilious adherents of the numeri- 
cal system at La Pitie. 

He used to insist on one small point with a certain 



308 MEDICAL ESSAYS. 

philological precision, namely, the true meaning of the 
word " cure." He would have it that to cure a pa- 
tient was simply to care for him. I refer to it as 
showing what his idea was of the relation of the physi- 
cian to the patient. It was indeed to care for him, as 
if his life were bound up in him, to watch his incom- 
ings and outgoings, to stand guard at every avenue 
that disease might enter, to leave nothing to chance ; 
not merely to throw a few pills and powders into one 
pan of the scales of Fate, while Death the skeleton 
was seated in the other, but to lean with his whole 
weight on the side of life, and shift the balance in its 
favor if it lay in human power to do it. Such devo- 
tion as this is only to be looked for in the man who 
gives himself wholly up to the business of healing, 
who considers Medicine itself a Seience, or if not a 
science, is willing to follow it as an art, — the noblest 
of arts, which the gods and demigods of ancient relig- 
ions did not disdain to practise and to teach. 

The same zeal made him always ready to listen to 
any new suggestion which promised to be useful, at a 
period of life when many men find it hard to learn 
new methods and accept new doctrines. Few of his 
generation became so accomplished as he in the arts of 
direct exploration ; coming straight from the Parisian 
experts, I have examined many patients with him, and 
have had frequent opportunities of observing his skill 
in percussion and auscultation. 

One element in his success, a trivial one compared 
with others, but not to be despised, was his punctual- 
ity. He always carried two watches, — I doubt if he 
told why, any more than Dr. Johnson told what he did 
with the orange-peel, — but probably with reference to 
this virtue. He was as much to be depended upon at 



SCHOLASTIC AND BEDSIDE TEACHING. 309 

the appointed time as the solstice or the equinox. 
There was another point I have heard him speak of as 
an important rule with him ; to come at the hour when 
he was expected ; if he had made his visit for several 
days successively at ten o'clock, for instance, not to 
put it off, if he could possibly help it, until eleven, and 
so keep a nervous patient and an anxious family wait- 
ing for him through a long, weary hour. 

If I should attempt to characterize his teaching, I 
should say that while it conveyed the best results of 
his sagacious and extended observation, it was sin^u- 
larly modest, cautious, simple, sincere. Nothing was 
for show, for self-love ; there was no rhetoric, no dec- 
lamation, no triumphant " I told you so," but the 
plain statement of a clear-headed honest man, who 
knows that he is handling one of the gravest subjects 
that interest humanity. His positive instructions were 
full of value, but the spirit in which he taught inspired 
that loyal love of truth which lies at the bottom of all 
real excellence. 

I will not say that, during his long career, Dr. Jack- 
son never made an enemy. I have heard him tell how, 
in his very early days, old Dr. Danforth got into a 
towering passion with him about some professional 
consultation, and exploded a monosyllable or two of 
the more energetic kind on the occasion. I remember 
that that somewhat peculiar personage, Dr. Water- 
house, took it hardly when Dr. Jackson succeeded to 
his place as Professor of Theory and Practice. A 
young man of Dr. Jackson's talent and energy could 
hardly take the position that belonged to him without 
crowding somebody in a profession where three in a 
bed is the common rule of the household. But he was 
a peaceful man and a peace-maker all his days. No 



310 MEDICAL ESSAYS* 

man ever did more, if so much, to produce and main- 
tain the spirit of harmony for which we consider our 
medical community as somewhat exceptionally distin- 
guished. 

If this harmony should ever be threatened, I could 
wish that every impatient and irritable member of the 
profession would read that beautiful, that noble Pref- 
ace to the " Letters," addressed to John Collins War- 
ran. I know nothing finer in the medical literature of 
all time than this Prefatory Introduction. It is a 
golden prelude, fit to go with the three great Prefaces 
which challenge the admiration of scholars, — Calvin's 
to his Institutes, De Thou's to his History, and Casau- 
bon's to his Polybius, — not because of any learning 
or rhetoric, though it is charmingly written, but for a 
spirit flowing through it to which learning and rhet- 
oric are but as the breath that is wasted on the air to 
the blood that warms the heart. 

Of a similar character is this short extract which I 
am permitted to make from a private letter of his to 
a dear young friend. He was eighty-three years old 
at the time of writing it. 

" I have not loved everybody whom I have known, 
but I have striven to see the good points in the char- 
acters of all men and women. At first I must have 
done this from something in my own nature, for I was 
not aware of it, and yet was doing it without any plan, 
when one day, sixty years ago, a friend whom I loved 
and respected said this to me, 4 Ah, James, I see that 
you are destined to succeed in the world, and to make 
friends, because you are so ready to see the good points 
in the characters of those you meet.' ' 

I close this imperfect notice of some features in the 
character of this most honored and beloved of physi- 



SCHOLASTIC AND BEDSIDE TEACHING. 311 

cians by applying to him the words which were writ- 
ten of William Ileberden, whose career was not unlike 
his own, and who lived to the same patriarchal age. 

" From his early youth he had always entertained a 
deep sense of religion, a consummate love of virtue, 
an ardent thirst after knowledge, and an earnest de- 
sire to promote the welfare and happiness of all man- 
kind. By these qualities, accompanied with great 
sweetness of manners, he acquired the love and esteem 
of all good men, in a degree which perhaps very few 
have experienced; and after passing an active life 
with the uniform testimony of a good conscience, he 
became an eminent example of its influence, in the 
cheerfulness and serenity of his latest age." 

Such was the man whom I offer to you as a model, 
young gentlemen, at the outset of your medical career. 
I hope that many of you will recognize some traits of 
your own special teachers scattered through various 
parts of the land in the picture I have drawn. Let 
me assure you that whatever you may learn in this or 
any other course of public lectures, — and I trust you 
will learn a great deal, — the daily guidance, counsel, 
example, of your medical father, for such the Oath of 
Hippocrates tells you to consider your preceptor, will, 
if he is in any degree like him of whom I have spoken, 
be the foundation on which all that we teach is reared, 
and perhaps outlive most of our teachings, as in Dr. 
Jackson's memory the last lessons that remained with 
him were those of his Oid Master. 



VI. 

THE MEDICAL PROFESSION IN MASSACHUSETTS.* 

The medical history of eight generations, told in an 
hour, must be in many parts a mere outline. The de- 
tails I shall give will relate chiefly to the first century. 
I shall only indicate the leading occurrences, with the 
more prominent names of the two centuries which fol- 
low, and add some considerations suggested by the facts 
which have been passed in review. 

A geographer who was asked to describe the tides of 
Massachusetts Bay, would have to recognize the cir- 
cumstance that they are a limited manifestation of 
a great oceanic movement. To consider them apart 
from this, would be to localize a planetary phenome- 
non, and to provincialize a law of the universe. The 
art of healing in Massachusetts lias shared more or less 
fully and readily the movement which, with its periods 
of ebb and flow, has been raising its level from age to 
age throughout the better part of Christendom. Its 
practitioners brought with them much of the knowledge 
and many of the errors of the Old World ; they have 
always been in communication with its wisdom and its 
folly ; it is not without interest to see how far the new 
conditions in which they found themselves have been 
favorable or unfavorable to the growth of sound medi- 
cal knowledge and practice. 

a A Lecture of a Course by members of the Massachusetts 
Historical Society, delivered before the Lowell Institute, Jan- 
uary 29, 1869. 



THE MEDICAL PROFESSION IN MASSACHUSETTS. 313 

The state of medicine is an index of the civilization 
of an age and country, — one of the best, perhaps, by 
which it can be judged. Surgery invokes the aid of 
all the mechanical arts. From the rude violences of 
the age of stone, — a relic of which we may find in 
the practice of Zipporah, the wife of Moses, a — to the 
delicate operations of to-day upon patients lulled into 
temporaiy insensibility, is a progress which presup- 
poses a skill in metallurgy and in the labors of the 
workshop and the laboratory it has taken uncounted 
generations to accumulate. Before the morphia which 
deadens the pain of neuralgia, or the quinine which 
arrests the fit of an ague, can find their place in our 
pharmacies, commerce must have perfected its ma- 
chinery, and science must have refined its processes, 
through periods only to be counted by the life of na- 
tions. Before the means which nature and art have 
put in the hands of the medical practitioner can be 
fairly brought into use, the prejudices of the vulgar 
must be overcome, the intrusions of false philosophy 
must be fenced out, and the partnership with the priest- 
hood dissolved. All this implies that freedom and ac- 
tivity of thought which belong only to the most ad- 
vanced conditions of society ; and the progress towards 
this is by gradations as significant of wide-spread 
changes, as are the varying states of the barometer 
of far-extended conditions of the atmosphere. 

Apart, then, from its special and technical interest, 
my subject has a meaning which gives a certain im- 
portance, and even dignity, to details in themselves 
trivial and almost unworthy of record. A medical 
entry in Governor Winthrop's journal may seem at 
first sight a mere curiosity ; but, rightly interpreted, it 
a Exodus iv. 25. 



314 MEDICAL ESSAYS. 

is a key to his whole system of belief as to the order 
of the universe and th? relations between man and his 
Maker. Nothing sheds such light on the superstitions 
of an age as the prevailing interpretation and treat- 
ment of disease. When the touch of a profligate 
monarch was a cure for one of the most inveterate of 
maladies, when the common symptoms of hysteria were 
prayed over as marks of demoniacal possession, we 
might well expect the spiritual realms of thought to be 
peopled with still stranger delusions. 

Let us go before the Pilgrims of the Mayflower, and 
look at the shores on which they were soon to land. A 
wasting pestilence had so thinned the savage tribes 
that it was sometimes piously interpreted as having 
providentially prepared the way for the feeble band of 
exiles. Cotton Mather, who, next to the witches, hated 
the " tawnies," " wild beasts," "blood-hounds," "rat- 
tlesnakes," " infidels," as in different places he calls 
the unhappy Aborigines, describes the condition of 
things in his lively way, thus : — 

"The Indians in these Parts had newly, even about 
a Year or Two before, been visited with such a prodi- 
gious Pestilence ; as carried away not a Tenth, but 
Nine Parts of Ten (yea "t i^ said Nineteen of Twenty} 
among them: so that the Woods were almost cleared 
of those pernicious Creatures to make Room for a bet- 
ter Growth"" 

What this pestilence was has been much discussed. 
It is variously mentioned by different early writers as 
u the plague," " a great and grievous plague," " a sore 
consumption," as attended with spots which left un- 
healed places on those who recovered, as making the 
a Magnaliciy book i. chap. 2. 



THE MEDICAL PROFESSION IN MASSACHUSETTS. 315 

whole surface yellow as with a garment." Perhaps no 
disease answers all these conditions so well as small- 
pox. We know from different sources what frightful 
havoc it made among the Indians in after years, — in 
1631, for instance, when it swept away the aboriginal 
inhabitants of whole towns, 6 and in 1633. c We have 
seen a whole tribe, the Mandans, extirpated by it in 
our own day. The word " plague " was used very 
vaguely, as in the description of the " great sickness " 
found among the Indians by the expedition of 1622. d 
This same great sickness could hardly have been yel- 
low fever, as it occurred in the month of November. 
I cannot think, therefore, that either the scourge of 
the East or our Southern malarial pestilence was the 
disease that wasted the Indians. As for the yellow- 
ness like a garment, that is too familiar to the eyes of 
all who have ever looked on the hideous mask of con- 
fluent variola. 

Without the presence or the fear of these exotic 
maladies, the forlorn voyagers of the Mayflower had 
sickness enough to contend with. At their first land- 
ing at Cape Cod, gaunt and hungry and longing for 
fresh food, they found upon the sandy shore "great 
mussels, and very fat and full of sea-pearl." Sailors 
and passengers indulged in the treacherous delicacy, 
which seems to have been the sea-clam; and found 
that these mollusks, like the shell the poet tells of, 
remembered their august abode, and treated the way- 
worn adventurers to a gastric reminiscence of the heav- 
ing billows. In the mean time it blew and snowed 



-o 



a Young, Chronicles of the Pilgrims, p. 183, note. 
6 Holmes's Annals, vol. i. p. 211, note. 
' Young, Chronicles of Massachusetts, p. 386. 
d Chronicles of the Pilgrims, p. 302. 



316 MEDICAL ESSAYS. 

and froze. The water turned to ice on their clothes, 
and made them many times like coats of iron. Ed- 
ward Tilley had like to have "sounded" with cold. 
The gunner, too, was sick unto death, but "hope of 
trucking " kept him on his feet, — a Yankee, it should 
seem, when he first touched the shore of New England. 
Most, if not all, got colds and coughs, which after- 
wards turned to scurvy, whereof many died. 6 

How can we wonder that the crowded and tempest- 
tossed voyagers, many of them already suffering, should 
have fallen before the trials of the first winter in Plym- 
outh? Their imperfect shelter, their insufficient sup- 
ply of bread, their salted food, now in unwholesome 
condition, account too well for the diseases and the 
mortality that marked this first dreadful season ; weak- 
ness, swelling of the limbs, and other signs of scurvy, 
betrayed the want of proper nourishment and protec- 
tion from the elements. In December six of their 
number died, in January eight, in February, seven- 
teen, in March thirteen. With the advance of spring 
the mortality diminished, the sick and lame began to 
recover, and the colonists, saddened but not disheart- 
ened, applied themselves to the labors of the opening 
year. c 

One of the most pressing needs of the early colonists 
must have been that of physicians and surgeons. In 
Mr. Savage's remarkable Genealogical Dictionary of 
the first settlers who came over before 1692 and their 
descendants to the third generation, I find scattered 
through the four crowded volumes the names of one 
hundred and thirty-four medical practitioners. Of 

° Chronicles of the Pilgrims, p. 119. 

4 Ibid. pp. 138, 151. e Ibid. p. 198. 



THE MEDICAL PROFESSION IN MASSACHUSETTS. 317 

these, twelve, and probably many more, practised sur- 
gery; three were barber-surgeons. A little incident 
throws a glimmer from the dark lantern of memory 
upon William Dinely, one of these practitioners with 
the razor and the lancet. He was lost between Boston 
and Roxbury in a violent tempest of wind and snow ; 
ten days afterwards a son was born to his widow, and 
with a touch of homely sentiment, I had almost said 
poetry, they called the little creature " Fathergone " 
Dinely. Six or seven, probably a larger number, were 
ministers as well as physicians, one of whom, I am 
sorry to say, took to drink and tumbled into the Con- 
necticut River, and so ended. One was not only doc- 
tor, but also schoolmaster and poet. One practised 
medicine and kept a tavern. One was a butcher, but 
calls himself a surgeon in his will, a union of callings 
which suggests an obvious pleasantry. One female 
practitioner, employed by her own sex, — Ann Moore, 
— was the precursor of that intrepid sisterhood whose 
cause it has long been my pleasure and privilege to 
advocate on all fitting occasions. 

Outside of this list I must place the name of Thomas 
Wilkinson, who was complained of, in 1676, for prac- 
tising contrary to law. 

Many names in the catalogue of these early physi- 
cians have been associated, in later periods, with the 
practice of the profession, — among them, Boylston, 
Clark, Danforth, Homan, Jeffrey, Kittredge, Oliver, 
Peaslee, Randall, Shattuck, Thacher, Wellington, Wil- 
liams, Woodward. Touton was a Huguenot, Burch- 
sted a German from Silesia, Lunerus a German or a 
Pole ; "Pighogg Churrergeon," I hope, for the honor 
$f the profession, was only Peacock disguised under 



318 MEDICAL ESSAYS. 

this alias, which would not, I fear, prove very attract- 
ive to patients. 

What doctrines and practice were these colonists 
likely to bring with them ? 

Two principal schools of medical practice prevailed 
in the Old World during the greater part of the seven- 
teenth century. The first held to the old methods of 
Galen : its theory was that the body, the microcosm, 
like the macrocosm, was made up of the four elements 
— fire, air, water, earth ; having respectively the qual- 
ities hot, dry, moist, cold. The body was to be pro- 
served in health by keeping each of these qualities in 
its natural proportion ; heat, by the proper tempera- 
ture ; moisture, by the due amount of fluid ; and so 
as to the rest. Diseases which arose from excess of 
heat were to be attacked by cooling remedies; those 
from excess of cold, by heating ones ; and so of the 
other derangements of balance. This was truly the 
principle of contraria contrariis^ which ill-informed 
persons have attempted to make out to be the general 
doctrine of medicine, whereas there is no general dogma 
other than this : disease is to be treated by anything 
that is proved to cure it. The means the Galenist 
employed were chiefly diet and vegetable remedies, 
with the use of the lancet and other depleting agents. 
He attributed the four fundamental qualities to differ- 
ent vegetables, in four different degrees : thus chicory 
was cold in the fourth degree, pepper was hot in the 
fourth, endive was cold and dry in the second, and bit- 
ter almonds were hot in the first and dry in the second 
degree. When we say " cool as a cucumber," we are 
talking Galenism. The seeds of that vegetable ranked 
as one of " the four greater cold seeds " of this system. 



THE MEDICAL PROFESSION IN MASSACHUSETTS. 319 

Galenism prevailed mostly in the south of Europe and 
France. The readers of Moliere will have no difficulty 
in recalling some of its favorite modes of treatment, 
and the abundant mirth he extracted from them. 

These Galenists were what we should call " herb-doc- 
tors " to-day. Their insignificant infusions lost credit 
after a time ; their absurdly complicated mixtures ex- 
cited contempt, and their nauseous prescriptions pro- 
voked loathing and disgust. A simpler and bolder 
practice found welcome in Germany, depending chiefly 
on mineral remedies, mercury, antimony, sulphur, ar- 
senic, and the use, sometimes the secret use, of opium. 
Whatever we think of Paracelsus, the chief agent in 
the introduction of these remedies, and whatever limits 
we may assign to the use of these long-trusted mineral 
drugs, there can be no doubt that the chemical school, 
as it was called, did a great deal towards the expur- 
gation of the old, overloaded, and repulsive pharma- 
copoeia. We shall find evidence in the practice of 
our New-England physicians of the first century, that 
they often employed chemical remedies, and that, by 
the early part of the following century, their chief 
trust was in the few simple, potent drugs of Para- 
celsus. 

We have seen that many of the practitioners of 
medicine, during the first century of New England, 
were clergymen. This relation between medicine and 
theology has existed from a very early period ; from 
the Egyptian priest to the Indian medicine-man, the 
alliance has been maintained in one form or another. 
The partnership was very common among our British 
ancestors. Mr. Ward, the Yicar of Stratf ord-on-Avon, 
himself a notable 'example of the union of the two char- 
acters, writing about 1660, says, — 



320 MEDICAL ESSAYS. 

" The Saxons had their blood-letters, but under the 
Normans physicke, begunne in England ; 300 years 
agoe itt was not a distinct profession by itself, but 
practised by men in orders, witness Nicholas de Tern- 
ham, the chief English physician and Bishop of Dur- 
ham ; Hugh of Everham, a physician and cardinal ; 
Grysant, physician and pope ; John Chambers, Dr. of 
Physick, was the first Bishop of Peterborough ; Paul 
Bush, a bachelor of divinitie in Oxford, was a man 
well read in physick as well as divinitie, he was the 
first bishop of Bristol. 

" Again in King Richard the Second's time physi- 
cians and divines were not distinct professions ; for one 
Tydeman, Bishop of Landaph and Worcester, was 
physician to King Richard the Second." 6 

This alliance may have had its share in creating and 
keeping up the many superstitions which have figured 
so largely in the history of medicine. It is curious to 
see that a medical work left in manuscript by the Rev. 
Cotton Mather and hereafter to be referred to, is run- 
ning over with follies and superstitious fancies ; while 
his contemporary and fellow-townsman, William Doug- 
lass, relied on the same few simple remedies which, 
through Dr. Edward Holyoke and Dr. James Jackson, 
have come down to our own time, as the most impor- 
tant articles of the materia medica. 

Let us now take a general glance at some of the 
conditions of the early settlers ; and first, as to the 
healthfulness of the climate. The mortality of the 
season that followed the landing of the Pilgrims at 
Plymouth has been sufficiently accounted for. After 

° Diary of /he Rev. John Ward, A. J/., p. 117. London, 1839. 
6 Ibid. p. 160. 



THE MEDICAL PROFESSION IN MASSACHUSETTS. 321 

this, the colonists seem to have found the new country- 
agreeing very well with their English constitutions. 
Its clear air is the subject of eulogy. Its dainty springs 
of sweet water are praised not only by Higginson and 
Wood, but even the mischievous Morton says, that for 
its delicate waters Canaan came not near this country.* 
There is a tendency to dilate on these simple blessings, 
which reminds one a little of the Marchioness in Dick- 
ens's story, with her orange-peel-and-water beverage. 
Still more does one feel the warmth of coloring, — such 
as we expect from converts to a new faith, and settlers 
who want to entice others over to their clearings, — 
when Winslow speaks, in 1621, of "abundance of roses, 
white, red, and damask; single, but very sweet in- 
deed ; " a most of all, however, when, in the same con- 
nection, he says, " Here are grapes white and red, and 
very sweet and strong also." This of our wild grape, 
a little vegetable Indian, which scalps a civilized man's 
mouth, as his animal representative scalps his cranium. 
But there is something quite charming in Winslow' s 
picture of the luxury in which they are living. Lob- 
sters, oysters, eels, mussels, fish and fowl, delicious 
fruit, including the grapes aforesaid, — if they only 
had " kine, horses, and sheep," he makes no question 
but men would live as contented here as in any part 
of the world. We cannot help admiring the way in 
which they took their trials, and made the most of their 
blessings. 

" And how Content they were," says Cotton Mather, 
" when an Honest Man, as I have heard, inviting his 
Friends to a Dish of Clams, at the Table gave Thanks 
to Heaven, who had given them to suck the abun- 

a Chronicles of the Pilgrims, p. 129, note. 
b Ibid. p. 234. 
21 



322 MEDICAL ESSAYS. 

dance of the Seas, and of the Treasures hid in the 
Sands!" a 

Strangely enough, as it would seem, except for this 
buoyant determination to make the best of everything, 
they hardly appear to recognize the difference of the 
climate from that which they had left. After almost 
three years' experience, Winslow says, he can scarce 
distinguish New England from Old England, in respect 
of heat and cold, frost, snow, rain, winds, etc. The 
winter, he thinks (if there is a difference), is sharper 
and longer ; but yet he may be deceived by the want 
of the comforts he enjoyed at home, lie cannot con- 
ceive any climate to agree better with the constitution 
of the English, not being oppressed with extremity of 
heats, nor nipped by biting cold : — 

" By which means, blessed be God, we enjoy our 
health, notwithstanding those difficulties we have un- 
dergone, in such a measure as would have been ad- 
mired, if we had lived in England with the like 
means." b 

Edward Johnson, after mentioning the shifts to 
which they were put for food, says, — 

w * And yet, methinks, our children are as cheerful, 
fat, and lusty, with feeding upon those mussels, clams, 
and other fish, as they were in England with their fill 
of bread." c 

Higginson, himself a dyspeptic, " continually in phy- 
sic," as he says, and accustomed to dress in thick cloth- 
ing, and to comfort his stomach with drink that was 
" both strong and stale," d — the " jolly good ale and 

a Mar/nalia, book i. chap. 5. 

b Chronicles of the Pilr/rims, pp. 369, 370. 

• Chron. of Mass. p. 352, note. 

d Ibid. pp. 251, 252. 



THE MEDICAL PROFESSION IN MASSACHUSETTS. 323 

old," I suppose, of free and easy Bishop Still's song, 

— found that he both could and did oftentimes drink 
New England water very well, — which he seems to 
look upon as a remarkable feat. He could go as light- 
clad as any, too, with only a light stuff cassock upon 
his shirt, and stuff breeches without linings. Two of 
his children were sickly : one, — little misshapen Mary, 

— died on the passage, and, in her father's words, 
" was the first in our ship that was buried in the bow- 
els of the great Atlantic sea ; " a the other, who had 
been " most lamentably handled " by disease, recovered 
almost entirely " by the very wholesomeness of the air, 
altering, digesting, and drying up the cold and crude 
humors of the body." Wherefore, he thinks it a wise 
course for all cold complexions to come to take physic 
in New England, and ends with those often quoted 
words, that " a sup of New England's air is better than 
a whole draught of Old England's ale." 6 Mr. Hig- 
ginson died, however, " of a hectic fever," a little more 
than a year after his arrival. 

The medical records which I shall cite show that 
the colonists were not exempt from the complaints of 
the Old World. Besides the common diseases to which 
their descendants are subject, there were two others, — ■ 
to say nothing of the dreaded small-pox, which later 
medical science has disarmed, — little known among 
us at the present day, but frequent among the first set- 
tlers. The first of these was the scurvy, already men- 
tioned, of which Winthrop speaks in 1630, saying, 
that it proved fatal to those who fell into discontent, 
and lingered after their former conditions in England ; 
the poor homesick creatures in fact, whom we so forget 
in our florid pictures of the early times of the little 
a Chron. of Mass. p. 223. b Ibid.^. 252. 



324 MEDICAL ESSAYS. 

band in the wilderness. Many who were suffering 
from scurvy got well when the Lyon arrived from 
England, bringing store of juice of lemons." The Gov- 
ernor speaks of another case in 1G44 ; and it seems 
probable that the disease was not of rare occurrence. 

The other complaint from which they suffered, but 
which has nearly disappeared from among us, was in- 
termittent fever, or fever and ague. I investigated the 
question as to the prevalence of this disease in New 
England, in a dissertation, which was published in a 
volume with other papers, in the year 1838. I can 
add little to the facts there recorded. One which es- 
caped me was, that Joshua Scottow, in " Old Men's 
Tears," dated 1691, speaks of " shaking agues," as 
among the trials to which they had been subjected. 
The outline map of New England, accompanying the 
dissertation above referred to, indicates all the places 
where I had evidence that the disease had originated. 
It was plain enough that it used to be known in many 
localities where it has long ceased to be feared. Still 
it was and is remarkable to see what a clean bill of 
health in this particular respect our barren soil in- 
herited with its sterility. There are some malarious 
spots on the edge of Lake Champlain, and there have 
been some temporary centres of malaria, within the 
memory of man, on one or more of our Massachusetts 
rivers, but these are Jiarmless enough, for the most 
part, unless the millers dam them, when they are apt 
to retaliate with a whiff from their meadows, that sets 
the whole neighborhood shaking with fever and ague. 

The Pilgrims of the Mayflower had with them a 
good physician, a man of standing, a deacon of their 
a Wintlirop's New England, vol. i. pp. 44, 45. 



THE MEDICAL PROFESSION IN MASSACHUSETTS. 325 

church, one whom they loved and trusted, Dr. Samuel 
Fuller. But no medical skill could keep cold and 
hunger and bad food, and, probably enough, desperate 
homesickness in some of the feebler sort, from doing 
their work. No detailed record remains of what they 
suffered or what was attempted for their relief during 
the first sad winter. The graves of those who died 
were levelled and sowed with grain that the losses of 
the little band might not be suspected by the savage 
tenants of the wilderness, and their story remains un- 
told. 

Of Dr. Fuller's practice, at a later period, we have 
an account in a letter of his to Governor Bradford, 
dated June, 1630. " I have been to Matapan " (now 
Dorchester), he says, " and let some twenty of those 
people blood." b Such wholesale depletion as this, ex- 
cept with avowed homicidal intent, is quite unknown 
in these days ; though I once saw the noted French sur- 
geon, Lisfranc, in a fine phlebotomizing frenzy, order 
some ten or fifteen patients, taken almost indiscrimi- 
nately, to be bled in a single morning. 

Dr. Fuller's two visits to Salem, at the request of 
Governor Endicott, seem to have been very satisfactory 
to that gentleman/ Morton, the wild fellow of Merry 
Mount, gives a rather questionable reason for the Gov- 
ernor's being so well pleased with the physician's do- 
ings. The names under which he mentions the two 
personages, it will be seen, are not intended to be com- 
plimentary. "Dr. Noddy did a great cure for Cap- 
tain Littleworth. He cured him of a disease called a 
wife." d William Gager, who came out with Win* 

a Holmes's Annals, vol. i. p. 168, note. 

6 Chron. of Mass. -p. 312. 

c Ibid. p. 32. * Ibid. p. 131. 



326 MEDICAL ESSAYS. 

throp, is spoken of as " a right godly man and skilful 
chyrurgeon," but died of a malignant fever not very 
long after his arrival." 

Two practitioners of the ancient town of Newbury 
are entitled to special notice, for different reasons. 
The first is Dr. John Clark, who is said by tradition to 
have been the first regularly educated physician who 
resided in New England. His portrait, in close-fitting 
skull-cap, with long locks and venerable flowing beard, 
is familiar to our eyes on the wall of our Society's ante- 
chamber. His left hand rests upon a skull, his right 
hand holds an instrument which deserves a passing com- 
ment. It is a trephine, a surgical implement for cut- 
ting round pieces out of broken skulls, so as to get at 
the fragments which have been driven in, and lift them 
up. It has a handle like that of a gimlet, with a claw 
like a hammer, to lift with, I suppose, which last con- 
trivance I do not see figured in my books. But the 
point I refer to is this : the old instrument, the trejxtn, 
had a handle like a wimble. — what we call a brace or 
bit-stock. The trephine is not mentioned at all in 
Peter Lowe's book, London, 1634 ; nor in Wiseman's 
great work on Surgery, London, 1676 ; nor in the 
translation of Dionis, published by Jacob Tonson, in 
1710. In fact it was only brought into more general 
use by Cheselden and Sharpe so late as the beginning 
of the last century. 6 As John Clark died in 1661, it 
is remarkable to see the last fashion in the way of skull- 
sawing contrivances in his hands, — to say nothing of 
the claw on the handle, and a Hey's saw. so called in 
England, lying on the table by him, and painted there 
more than a hundred years before Hey was born. This 

" "Winthrop's New England, vol. i. p. 33. 
6 British and For. Med. Rev. vol. xvi. p. 49. 



THE MEDICAL PROFESSION IN MASSACHUSETTS. 327 

saw is an old invention, perhaps as old as Hippocrates, 
and may be seen figured in the " Armamentarium Chi- 
rurgicnm " of Scultetus, or in the Works of Ambroise 
Pare\ 

Dr. Clark is said to have received a diploma before 
he came, for skill in lithotomy." He loved horses, as a 
good many doctors do, and left a good property, as they 
all ought to do. His grave and noble presence, with 
the few facts concerning him, told with more or less 
traditional authority, give us the feeling that the peo- 
ple of Newbury, and afterwards of Boston, had a wise 
and skilful medical adviser and surgeon in Dr. John 
Clark. 

The venerable town of Newbury had another phy-. 
sician who was less fortunate. The following is a court 
record of 1652 : — 

" This is to certify whom it may concern, that we 
the subscribers, being called upon to testify against 
[doctor] William Snelling for words by him uttered, 
affirm that being in way of merry discourse, a health 
being drank to all friends, he answered, — 

1 1 '11 pledge my friends, 
And for my foes 
A plague for their heels 
And,' — 

[a similar malediction on the other extremity of their 
feet.] 

" Since when he hath affirmed that he only intended 
the proverb used in the west country, nor do we believe 
he intended otherwise. 

[Signed] William Thomas. 

Thomas Milward. 
" March 12th 1651, All which I acknowledge, and I 
a Thacker, Med. Biography, p. 222. 



328 MEDICAL ESSAYS. 

am sorry I did not expresse my intent, or that I was 
so weak as to use so foolish a proverb. 

[Signed] Gulielmus Snelling." 

Notwithstanding this confession and apology, the 
record tells us that " William Snelling in his present- 
ment for cursing is fined ten shillings and the fees of 
court." a 

I will mention one other name among those of the 
Fathers of the medical profession in New England. 
The "apostle" Eliot says, writing in 1647, "We 
never had but one anatomy in the country, which Mr. 
Giles Firman, now in England, did make and read 
upon very well." b 

Giles Firmin, as the name is commonly spelled, 
practised physic in this country for a time. He seems 
to have found it a poor business ; for, in a letter to 
Governor Winthrop, he says, " I am strongly sett upon 
to studye divinitie : my studyes else must be lost, for 
physick is but a meene helpe." c 

Giles Firmin's Lectures on Anatomy were the first 
scientific teachings of the New World. While the 
Fathers were enlightened enough to permit such in- 
structions, they were severe in dealing with quackery; 
for, in 1631, our court records show that one Nich- 
olas Knopp, or Knapp, was sentenced to be fined or 
whipped " for taking upon him to cure the scurvey by 
a water of noe worth nor value, which he solde att a very 
deare rate." d Empty purses or sore backs would be 
common with us to-day if such a rule were enforced. 

Besides the few worthies spoken of, and others whose 

a Coffin, Hist, of Newbury, p. 55. 

6 Hist. Coll. 8d Series, vol. iv. p. 57. 

c Winthrop Papers in Hist. Coll. 4th Series, vol. vii. p. 273. 

d Mass. Col. Court Records, vol. i. p. G3. 



THE MEDICAL PROFESSION IN MASSACHUSETTS. 329 

names I have not space to record, we must remember 
that there were many clergymen who took charge 
of the bodies as well as the souls of their patients, 
among them two Presidents of Harvard College, — 
Charles Chauncy and Leonard Hoar, — and Thomas 
Thacher, first minister of the " Old South," author of 
the earliest medical treatises printed in the country," 
whose epitaph in Latin and Greek, said to have been 
written by Eleazer, an " Indian Youth " and a mem- 
ber of the Senior Class of Harvard College, may be 
found in the "Magnalia." 6 I miss this noble savage's 
name in our triennial catalogue ; and as there is many 
a slip between the cup and lip, one is tempted to guess 
that he may have lost his degree by some display of 
his native instinct, — possibly a flourish of the tom- 
ahawk or scalping-knife. However this may have 
been, the good man he celebrated was a notable in- 
stance of the Angelical Conjunction, as the author of 
the " Magnalia " calls it, of the offices of clergyman 
and medical practitioner. 

Michael Wigglesworth, author of the " Day of 
Doom," attended the sick, " not only as a Pastor, but 
as a Physician too, and this, not only in his own town, 
but also in all those of the vicinity. " c Mather says 
of the sons of Charles Chauncy, "All of these did, 
while they had Opportunity, Preach the Gospel ; and 
most, if not all of them, like their excellent Father be- 
fore them, had an eminent skill in physick added unto 
their other accomplishments," etc. Roger Williams is 

a A Brief Rule to Guide the Common People in Small-pox and 
Measles. 1674. 

6 Book iii. chap. 26. 

c Cotton Mather's Funeral Sermon, preached January 24, 
1705. 



330 MEDICAL ESSAYS. 

said to have saved many in a kind of pestilence which 
swept away many Indians. 

To these names must be added, as sustaining a cer- 
tain relation to the healing art, that of the first Gov- 
ernor Winthrop, who is said by John Cotton to have 
been " Help for our Bodies by Physick [and] for our 
Estates by Law," a and that of his son, the Governor 
of Connecticut, who, as we shall see, was as much phy- 
sician as magistrate. 

I had submitted to me for examination, in 1862, a 
manuscript found among the Winthrop Papers, marked 
with the superscription, " For my worthy friend Mr. 
Wintrop," dated in 1643, London, signed Edward 
Stafford, and containing medical directions and pre- 
scriptions. It may be remembered by some present 
that I wrote a report on this paper, which was pub- 
lished in the " Proceedings" of this Society. Whether 
the paper was written for Governor John Winthrop 
of Massachusetts, or for his son, Governor John of 
Connecticut, there is no positive evidence that I have 
been able to obtain. It is very interesting, however, 
as giving short and simple practical directions, such as 
would be most like to be wanted and most useful, in 
the opinion of a physician in repute of that day. 

The diseases prescribed for are play tie, small-pox, 
fevers, king' s evil, insanity, falling-sickness, and the 
like ; with such injuries as broken bones, dislocations, 
and burning with gunpowder. The remedies are of 
three kinds : simples, such as St. John's wort, Clown's 
all-heal, elder, parsley, maidenhair ; mineral drugs, 
such as lime, saltpetre, Armenian bole, crocus metal- 
lorum, or sulphuret of antimony ; and thaumaturgic 
or mystical, of which the chief is, " My black powder 
a Magnolia) book ii. chap. 4. 



THE MEDICAL PROFESSION IN MASSACHUSETTS. 331 

against the plague, small-pox ; purples, all sorts of f ea- 
vers ; Poyson ; either, by Way of Prevention or after 
Infection." This marvellous remedy was made by 
putting live toads into an earthen pot so as to half fill 
it, and baking and burning them " in the open ayre, 
not in an house," — concerning which latter possibility 
I suspect Madam Winthrop would have had something 
to say, — until they could be reduced by pounding, 
first into a brown, and then into a black, powder. 
Blood-letting in some inflammations, fasting in the 
early stage of fevers, and some of those peremptory 
drugs with which most of us have been well acquainted 
in our time, the infragrant memories of which I will 
not pursue beyond this slight allusion, are among his 
remedies. 

The Winthrops, to one of whom Dr. Stafford's di- 
rections were addressed, were the medical as well as 
the political advisers of their fellow-citizens for three 
or four successive generations. One of them, Gov- 
ernor John of Connecticut, practised so extensively, 
that, but for his more distinguished title in the State, 
he would have been remembered as the Doctor. The 
fact that he practised in another colony, for the most 
part, makes little difference in the value of the rec- 
ords we have of his medical experience, which have 
fortunately been preserved, and give a very fair idea, 
in all probability, of the way in which patients were 
treated in Massachusetts, when they fell into intelli- 
gent and somewhat educated hands, a little after the 
middle of the seventeenth century. 

I have before me, while writing, a manuscript col- 
lection of the medical cases treated by him, and re- 
corded at the time in his own hand, which has been 
intrusted to me by our President, his descendant. 



332 MEDICAL ESSAYS. 

They are generally marked Hartford, and extend from 
the year 1657 to 1669. From these manuscripts, and 
from the letters printed in the Winthrop Papers pub- 
lished by our Society, I have endeavored to obtain 
some idea of the practice of Governor John Winthrop, 
Junior. The learned eye of Mr. Pulsifer woidd have 
helped me, no doubt, as it has done in other cases ; but 
I have ventured this time to attempt finding my own 
way among the hieroglyphics of these old pages. By 
careful comparison of many prescriptions, and by the 
aid of Schroder, Salmon, Culpeper, and other old 
compilers, I have deciphered many of his difficult par- 
agraphs with their mysterious recipes. 

The Governor employed a number of the simples 
dear to ancient women, — elecampane and elder and 
wormwood and anise and the rest; but he also em- 
ployed certain mineral remedies, which he almost al- 
ways indicates by their ancient symbols, or by a name 
which should leave them a mystery to the vulgar. I 
am now prepared to reveal the mystic secrets of the 
Governor's beneficent art, which rendered so many good 
and great as well as so many poor and dependent peo- 
ple his debtors, — at least, in their simple belief, — for 
their health and their lives. 

His great remedy, which he gave oftener than any 
other, was nitre ; which he ordered in doses of twenty 
or thirty grains to adults, and of three grains to in- 
fants. Measles, colics, sciatica, headache, giddiness, 
and many other ailments, all found themselves treated, 
and I trust bettered, by nitre ; a pretty safe medicine 
in moderate doses, and one not likely to keep the good 
Governor awake at night, thinking whether ii might 
not kill, if it did not cure. We may say as much for 
spermaceti, which he seems to have considered " the 



THE MEDICAL PROFESSION IN MASSACHUSETTS. 333 

sovereign' st thing' on earth " for inward bruises, and 
often prescribes after falls and similar injuries. 

One of the next remedies, in point of frequency, 
which he was in the habit of giving, was (probably 
diaphoretic) antimony ; a mild form of that very ac- 
tive metal, and which, mild as it was, left his patients 
very commonly with a pretty strong conviction that 
they had been taking something that did not exactly 
agree with them. Now and then he gave a little iron 
or sulphur or calomel, but very rarely ; occasionally, a 
good, honest dose of rhubarb or jalap ; a taste of sting- 
ing horseradish, oftener of warming guiacum ; some- 
times an anodyne, in the shape of mithridate, — the 
famous old farrago, which owed its virtue to poppy 
juice ; a very often, a harmless powder of coral ; less 
frequently, an inert prescription of pleasing amber ; 
and (let me say it softly within possible hearing of 
his honored descendant), twice or oftener, — let us 
hope as a last resort, — an electuary of millijiedes, 
— sowbugs, if we must give them their homely Eng- 
lish name. One or two other prescriptions, of the 
many unmentionable ones which disgraced the phar- 
macopoeia of the seventeenth century, are to be found, 
but only in very rare instances, in the faded characters 
of the manuscript. 

The excellent Governor's accounts of diseases are so 
brief, that we get only a very general notion of the 
complaints for which he prescribed. Measles and 
their consequences are at first more prominent than 
any other one affection, but the common infirmities of 

a This is the remedy which a Boston divine tried to simplify. 
See Electuarium Novum Aleziphannacum, by Rev. Thomas Har- 
ward, lecturer at the Royal Chappell. Boston, 1732. This tract 
is in our Society's library. 



334 MEDICAL ESSAYS. 

both sexes and of all ages seem to have come under 
his healing hand. Fever and ague appears to have 
been of frequent occurrence. 

His published correspondence shows that many 
noted people were in communication with him as his 
patients. Roger Williams wants a little of his medi- 
cine for Mrs. Weekes's daughter ; worshipful John 
Haynes is in receipt of his powders ; troublesome Cap- 
tain Underbill wants "a little white vitterall " for his 
wife, and something to cure his wife's friend's neural- 
gia (I think his wife's friend's husband had a little 
rather have had it sent by the hands of Mrs. Under- 
bill, than by those of the gallant and discursive cap- 
tain) ; and pious John Davenport says, his wife " tooke 
but one halfe of one of the papers" (which probably 
contained the medicine he called rubila), " but could 
not beare the taste of it, and is discouraged from tak- 
ing any more;" and honored William Leete asks for 
more powders for his " poore little daughter " Graci- 
ana, though he found it " hard to make her take it," 
delicate, and of course sensitive, child as she was, lan- 
guishing and dying before her time, in spite of all the 
bitter tilings she swallowed, — God help all little chil- 
dren in the hands of dosing doctors and howling der- 
vishes ! Restless Samuel Gorton, now tamed by the 
burden of fourscore and two years, writes so touching 
an account of his infirmities, and expresses such over- 
flowing gratitude for the relief he has obtained from 
the Governor's prescriptions, wondering how " a thing 
so little in quantity, so little in sent, so little in taste, 
and so little to senee in operation, should beget and 
bring forth such efects," that we repent our hasty ex- 
clamation, and bless the memory of the good Gov- 
ernor, who gave relief to the worn-out frame of our 



THE MEDICAL PROFESSION IN MASSACHUSETTS. 335 

long-departed brother, the sturdy old heretic of Rhode 
Island. 

What was that medicine which so frequently occurs 
in the printed letters under the name of " rubila " ? 
It is evidently a secret remedy, and, so far as I know, 
lias not yet been made out. I had almost given it up 
in despair, when I found what appears to be a key to 
the mystery. In the vast multitude of prescriptions 
contained in the manuscripts, most of them written in 
symbols, I find one which I thus interpret : — 

" Four grains of (diaphoretic) antimony, with twenty 
grains of nitre, with a little salt of tin, making ru- 
bila" Perhaps something was added to redden the 
powder, as he constantly speaks of " rubifying " or 
" viridating " his prescriptions ; a very common prac- 
tice of prescribes, when their powders look a little too 
much like plain salt or sugar. 

Waitstill Winthrop, the Governor's son, "was a 
skilful physician," says Mr. Sewall, in his funeral ser- 
mon ; " and generously gave, not only his advice, but 
also his Medicines, for the healing of the Sick, which, 
by the Blessing of God, were made successful for the 
recovery of many." a His son John, a member of the 
Royal Society, speaks of himself as " Dr. Winthrop," 
and mentions one of his own prescriptions in a letter 
to Cotton Mather. Our President tells me that there 
was an heirloom of the ancient skill in his family, 
within his own remembrance, in the form of a certain 
precious eye-water, to which the late President John 
Quincy Adams ascribed rare virtue, and which he 
used to obtain from the possessor of the ancient recipe. 

a See also his epitaph in Life and Letters of John Winthrop, 
by his descendant, Hon. Robert C. Winthrop. 



336 MEDICAL ESSAYS. 

These inherited prescriptions are often treasured in 
families, I do not doubt, for many generations. When 
I was yet of trivial age, and suffering occasionally, as 
many children do, from what one of my Cambridge- 
port schoolmates used to call the " ager," — meaning 
thereby toothache or f aceaehe, — I used to get relief 
from a certain plaster which never went by any other 
name in the family than " Dr. Oliver." 

Dr. James Oliver was my great-great-grandfather, 
graduated in 1680, and died in 1703. This was, no 
doubt, one of his nostrums ; for nostrum, as is well 
known, means nothing more than our own or my own 
particular medicine, or other possession or secret, and 
physicians in old times used to keep their choice 
recipes to themselves a good deal, as we have had oc- 
casion to see. 

Some years ago I found among my old books a 
small manuscript marked " James Oliver. This Book 
Begun Aug. 12, (16)85." It is a rough sort of ac- 
count-book, containing among other things prescrip- 
tions for patients, and charges for the same, with 
counter-charges for the purchase of medicines and other 
matters. Dr. Oliver practised in Cambridge, where 
may be seen his tomb with inscriptions, and with sculp- 
tured figures that look more like Diana of the Ephe- 
sians, as given in Calmet's Dictionary, than like any 
angels admitted into good society here or elsewhere. 

I do not find any particular record of what his pa- 
tients suffered from, but I have carefully copied out 
the remedies he mentions, and find that they form a 
very respectable catalogue. Besides the usual sim- 
ples, elder, parsley, fennel, saffron, snake-root, worm- 
wood, I find the Elixir Proprietatis, with other elixirs 
and cordials, as if he rather fancied warming medi. 



THE MEDICAL PROFESSION IN MASSACHUSETTS. 337 

eines ; but lie called in the aid of some of the more 
energetic remedies, including iron, and probably mer- 
cury, as he bought two pounds of it at one time. 

The most interesting item is his bill against the es- 
tate of Samuel Pason of Roxbury, for services during 
his last illness. He attended this gentleman, — for 
such he must have been, by the amount of physic 
which he took, and which his heirs paid for, — from 
June 4th, 1696, to September 3d of the same year, — 
three months. I observe he charges for visits as well 
as for medicines, which is not the case in most of his 
bills. He opens the attack with a carminative appeal 
to the visceral conscience, and follows it up with good 
hard-hitting remedies for dropsy, — as I suppose the 
disease would have been called, — and finishes oft with 
a rallying dose of hartshorn and iron. 

It is a source of honest pride to his descendant that 
his bill, which was honestly paid, as it seems to have 
been honorably earned, amounted to the handsome 
total of seven pounds and two shillings. Let me add 
that he repeatedly prescribes plaster, one of which was 
very probably the " Dr. Oliver " that soothed my in- 
fant griefs, and for which I blush to say that my ven- 
erated ancestor received from Goodman Hancock the 
painfully exiguous sum of no pounds, no shillings, and 
sixpence. 

I have illustrated the practice of the first century, 
from the two manuscripts I have examined, as giving 
an impartial idea of its every-day methods. The Gov- 
ernor, Johannes Secundus, it is fair to remember, was 
an amateur practitioner, while my ancestor was a pro- 
fessed physician. Comparing their modes of treat- 
ment with the many scientific follies still prevailing in 
the Old World, and still more with the extraordinary 



338 MEDICAL ESSAYS. 

theological superstitions of the community in which 
they lived, we shall find reason, I think, to consider the 
art of healing as in a comparatively creditable state 
during the first century of New England. 

In addition to the evidence as to methods of treat- 
ment furnished by the manuscripts I have cited, I sub- 
join the following document, to which my attention 
was called by Dr. Shurtleff, our present Mayor. This 
is a letter of which the original is to be found in vol. 
lxix. page 10 of the " Archives " preserved at the 
State House in Boston. It will be seen that what the 
surgeon wanted consisted chiefly of opiates, stimulants, 
cathartics, plasters, and materials for bandages. The 
complex and varied formulae have given place to sim- 
pler and often more effective forms of the same reme- 
dies ; but the list and the manner in which it is made 
out are proofs of the good sense and schooling of the 
surgeon, who, it may be noted, was in such haste that 
he neglected all his stops. He might well be in a 
hurry, as on the very day upon which he wrote, a great 
body of Indians — supposed to be six or seven hun- 
dred — appeared before Hatfield ; and twenty-five res- 
olute young men of Hadley, from which town he wrote, 
crossed the river and drove them away. a 

IIadly May 30: 76 
M* Rawson S r 

What we have rec d by Tho : Houey the 
past month is not the cheifest of our wants as you 
have love for poor wounded I pray let us not want for 
these following medicines if you have not a speedy 
conveyance of them I pray send on purpose they are 
those things mentioned in my former letter but to pre- 
vent future mistakes 1 have wrote them att large wee 
" Holmes's Annals, vol. i. p. 381. 



THE MEDICAL PROFESSION IN MASSACHUSETTS. 339 



have great want with the greatest hast and speed let 
ns be supply ed. S r 

Y r Ser* 
Will Locke 

Emp: Diachyl: Cum Gum lb j 
ft j 
ft j 
ft j 
Siiij 

ft ij 

ft j 
ft ij 
ft ij 

3 ss 



° Imp. Ung' Basilic . . lb ij 
° Liniment Arcei . . . ft ij 

Ung' Nervin: lb ij 

01: Kosarum .... ft ij 
& 01: terebinth: .... ft ij 

Mithridat: ft j 

Diascordii ft j 

theriac: Andromac: . . ft ss 

Licortiie ft j 

Hord: Gallic: .... ft iiij 

Empl: Diapal: . . . ft iij 

Empl: De Miuo ... ft iij 

Empl: De Meliloti . . ft ij 

Empl: paracclsi ... ft j 

Oxycroceum .... ft j 
[Direction] for M r Edward Rawson Will: Locke 

Secr y : w th hast & speed humbly 
present These in 

Boston 
[Endorsed] 

Mr. Locke's Letter Rec d from the Governor 13 June & acquainted 
y e Council with it but could not obtaine any thing to be sent in an- 
swer thereto 13 June 1676 



De bctonica . . . 
Flor: chamemasli . . 
Flor: meliloti . . . 
Sal: prunella? . . . 
pul: Aloes .... 
« Sem: Anisi Santonicae 
Aq: theriacalis . . 
Spt: Cinnamomi . . 
Syr: Gariophyllor: . 
Syr: Rosarum Solut: 

Croci 

Old linnin as much as you 

can get 



I have given some idea of the chief remedies used 
by our earlier physicians, which were both Galenic and 
chemical ; that is, vegetable and mineral. They, of 
course, employed the usual perturbing medicines which 
Montaigne says are the chief reliance of their craft. 
There were, doubtless, individual practitioners who em- 
ployed special remedies with exceptional boldness and 
perhaps success, Mr. Eliot is spoken of, in a letter 
of William Leete to Winthrop, Junior, as being under 

a Crossed out in the letter. 
b " The last was broken." 



340 MEDICAL ESSAYS. 

Mr. Greenland's mercurial administrations. The lat- 
ter was probably enough one of these specialists. 

There is another class of remedies which appears to 
have been employed occasionally, but, on the whole, is 
so little prominent as to imply a good deal of common 
sense among the medical practitioners, as compared 
with the superstitions prevailing around them. I have 
said that I have caught the good Governor, now and 
then, prescribing the electuary of millipedes ; but he is 
entirely excused by the almost incredible fact that they 
were retained in the materia medica so late as when 
Eees's Cyclopaedia was published, and we there find 
the directions formerly given by the College of Edin- 
burgh for their preparation. Once or twice we have 
found him admitting still more objectionable articles 
into his materia medica ; in doing which, lam sorry 
to say that he coidd plead grave and learned authority. 
But these instances are very rare exceptions in a medi- 
cal practice of many years, which is, on the whole, very 
respectable, considering the time and circumstances. 

Some remedies of questionable though not odious 
character appear occasionally to have been employed 
by the early practitioners, but they were such as still 
had the support of the medical profession. Governor 
John Winthrop, the first, sends for East-Indian bezoar, 
with other commodities lie is writing for. 6 Governor 
Endicott sends him one he had of Mr. llumfrev. c I 
hope it was genuine, for they cheated infamously in the 
matter of this concretion, which ought to come out of 
an animal's stomach, but the real history of which re- 
sembles what is sometimes told of modern sausages. 

a Hist. Coll. 4th Series, vol. vii. p. 575. 

* Hist, of N. England, vol. ii. p. 385. Appendix. 

c Hist, Coll. 4th Series, vol. vii. p. 156. 



THE MEDICAL PROFESSION IN MASSACHUSETTS. 341 

There is a famous law-case of James the First's time, 
in which a goldsmith sold a hundred pounds' worth of 
what he called bezoar, which was proved to be false, 
and the purchaser got a verdict against him. Gov- 
ernor Endicott also sends Winthrop a unicorn's horn, 
which was the property of a certain Mrs. Beggarly, 
who, in spite of her name, seems to have been rich in 
medical knowledge and possessions." The famous 
Thomas Bartholinus wrote a treatise on the virtues of 
this f abulous-soimding remedy, which was published in 
1641, and republished in 1678. 

The " antimonial cup," a drinking vessel made of 
that metal, which, like our quassia-wood cups, might 
be filled and emptied in scecula scecidorum without ex- 
hausting its virtues, is mentioned by Matthew Cradock, 
in a letter to the elder Winthrop, but in a doubtful 
way, as it was thought, he says, to have shortened the 
days of Sir Nathaniel Eiche ; and Winthrop himself, as 
I think, refers to its use, calling it simply " the cup." b 
An antimonial cup is included in the inventory of Sam- 
uel Seabury, who died 1680, and is valued at five shil- 
lings. 6 There is a treatise entitled " The Universal]. 
Remedy, or the Vertues of the Anthnoniall Cup, By 
John Evans, Minister and Preacher of God's "Word, 
London, 1634," in our own Society's library. 

One other special remedy deserves notice, because 
of native growth. I do not know when Culver's root, 
Leptandra Virginica of our National Pharmacopoeia, 
became noted, but Cotton Mather, writing in 1716 to 
John Winthrop of New London, speaks of it as famous 
for the cure of consumptions, and wishes to get some 

a Hist Coll 4th Series, vol. vii. p. 156. 
6 Hist. o/N. England, vol. i. p. 394. 
• Thaeher's Medical Biography, p. 18. 



342 MEDICAL ESSAYS. 

of it, through his mediation, for Katharine, his eldest 
daughter." He gets it, and gives it to the " poor dam- 
sel," who is languishing, as he says, and who dies the 
next month, 6 — all the sooner, I have little doubt, for 
this uncertain and violent drug, with which the meddle- 
some pedant tormented her in that spirit of well-meant 
but restless quackery, which could touch nothing with- 
out making mischief, not even a quotation, and yet 
proved at length the means of bringing a great blessing 
to our community, as we shall see by and by ; so does 
Providence use our very vanities and infirmities for 
its wise purposes. 

Externally, I find the practitioners on whom I have 
chiefly relied used the plasters of Paracelsus, of melilot, 
diachylon, and probably diaphcenicon, all well known 
to the old pharmacopoeias, and some of them to the 
modern ones, — to say nothing of " my yellow salve," 
of Governor John, the second, for the composition of 
which we must apply to his respected descendant. 

The authors I find quoted are Barbette's Surgery, 
Camerarius on Gout, and Wecherus, of jill whom notices 
may be found in the pages of Haller and Vanderlin- 
den ; also, Reed's Surgery, and Nicholas Culpeper's 
Practice of Physic and Anatomy, the last as belonging 
to Samuel Seabury, chirurgeon, before mentioned. 
Nicholas Culpeper was a shrewd charlatan, and as im- 
pudent a varlet as ever prescribed for a colic ; but 
knew very well what he was about, and badgers the 
College with great vigor. A copy of Spigelius's 
famous Anatomy, in the Boston Athenaeum, has the 
names of Increase and Samuel Mather written in it, 
and was doubtless early overhauled by the youthful 

° Mather Papers in Hist. Coll. 4th Series, vol. viii. p. 420 
b Ibid., note. 



THE MEDICAL PROFESSION IN MASSACHUSETTS. 343 

Cotton, who refers to the great anatomist's singular 
death, among his curious stories in the "Magnalia," 
and quotes him among nearly a hundred authors whom 
he cites in his manuscript " The Angel of Bethesda." 
Dr. John Clark's " books and instruments, with several 
chirurgery materials in the closet," a were valued in his 
inventory at sixty pounds ; Dr. Matthew Fuller, who 
died in 1678, left a library valued at ten pounds ; and 
a surgeon's chest and drugs valued at sixteen pounds. 6 

Here we leave the first century and all attempts at 
any further detailed accounts of medicine and its practi- 
tioners. It is necessary to show in a brief glance what 
had been going on in Europe during the latter part of 
that century, the first quarter of which had been made 
illustrious in the history of medical science by the dis- 
covery of the circulation. 

Charles Barbeyrac, a Protestant in his religion, was 
a practitioner and teacher of medicine at Montpellier. 
His creed was in the way of his obtaining office ; but 
the young men followed his instructions with enthusi- 
asm. Religious and scientific freedom breed in and in, 
until it becomes hard to tell the family of one from 
that of the other. Barbeyrac threw overboard the old 
complex medical farragos of the pharmacopoeias, as Ins 
church had disburdened itself of the popish ceremonies. 

Among the students who followed his instructions 
were two Englishmen : one of them, John Locke, after- 
wards author of an " Essay on the Human Understand- 
ing," three years younger than his teacher ; the other, 
Thomas Sydenham, five years older. Both returned 
to England. Locke, whose medical knowledge is 
borne witness to by Sydenham, had the good fortune 
a Thacher's Med. Bwg. p. 222. b Ibid. p. 18. 



344 MEDICAL ESSAYS. 

to form a correct opinion on a disease from which the 
Earl of Shaftesbury was suffering, which led to an 
operation that saved his life. Less felicitous was his 
experience with a certain ancilla culinaria virgo, — 
which I am afraid would in those days have been trans- 
lated kitchen-wench, instead of lady of the culinary 
department, — who turned him -off after she had got 
tired of him, and called in another practitioner. This 
helped, perhaps, to spoil a promising doctor, and make 
an immortal metaphysician. At any rate, Locke laid 
down the professional wig and cane, and took to other 
studies. 

The name of Thomas Sydenham is as distinguished 
in the history of medicine as that of John Locke in 
philosophy. As Barbeyrac was found in opposition to 
the established religion, as Locke took the rational 
side against orthodox Bishop Stillingfleet, so Syden- 
ham went with Parliament against Charles, and was 
never admitted a Fellow by the College of Physicians, 
which, after he was dead, placed his bust in their hall 
by the side of that of Harvey. 

What Sydenham did for medicine was briefly this: 
he studied the course of diseases carefully, and espe- 
cially as affected by the particular season ; to patients 
with fever he gave air and cooling drinks, instead of 
smothering and heating them, with the idea of sweat- 
ing out their disease ; he ordered horseback exercise to 
consumptives ; he, like his teacher, used few and com- 
paratively simple remedies ; he did not give any drug 
at all, if he thought none was needed, but let well 
enough alone. He was a sensible man, in short, who 
applied his common sense to diseases which he had 

a Lode and Sydenham, p. 124. By John Brown, M. D. Edin- 
burgh, 1866. 



THE MEDICAL PROFESSION IN MASSACHUSETTS. 345 

studied with the best light of science that he could ob- 
tain. 

The influence of the reform he introduced must 
have been more or less felt in this country, but not 
much before the beginning of the eighteenth century, 
as his great work was not published until 1675, and 
then in Latin. I very strongly suspect that there was 
not so much to reform in the simple practice of the 
physicians of the new community, as there was in that 
of the learned big-wigs of the " College," who valued 
their remedies too much in proportion to their com- 
plexity, and the extravagant and fantastic ingredients 
which went to their making. 

During the memorable century which bred and bore 
the Revolution, the medical profession gave great 
names to our history. But John Brooks belonged to 
the State, and Joseph Warren belongs to the country 
and mankind, and to speak of them would lead me 
beyond my limited subject. There would be little 
pleasure in dwelling on the name of Benjamin Church ; 
and as for the medical politicians, like Elisha Cooke 
in the early part of the century, or Charles Jarvis, the 
" bald eagle of Boston," in its later years, whether 
their practice was heroic or not, their patients were, 
for he is a bold man who trusts one that is making 
speeches and coaxing voters, to meddle with the inter- 
nal politics of his corporeal republic. 

One great event stands out in the medical history of 
this eighteenth century ; namely, the introduction of 
fche practice of inoculation for small-pox. Six epidem- 
ics of this complaint had visited Boston in the course 
of a hundred years. a Prayers had been asked in the 

a W. Douglass's Diss. Concerning Inoc. p. 25. Boston, 1730. 



346 MEDICAL ESSAYS. 

churches for more than a hundred sick in a single 
day, and this many times. About a thousand persons 
had died in a twelvemonth, we are told, and, as we may 
infer, chiefly from this cause. 

In 1721, this disease, after a respite of nineteen 
years, again appeared as an epidemic. In that year it 
was that Cotton Mather, browsing, as was his wont, on 
all the printed fodder that came within reach of his 
ever-grinding mandibles, came upon an account of in- 
oculation as practised in Turkey, contained in the 
" Philosophical Transactions." He spoke of it to sev- 
eral physicians, who paid little heed to his story ; for 
they knew his medical whims, and had probably been 
bored, as we say now-a-days, many of them, with list- 
ening to his " Angel of Bethesda," and satiated with 
his speculations on the Nlshmath Chajim. 

The Reverend Mather, — I use a mode of expres- 
sion he often employed when speaking of his honored 
brethren, — the Reverend Mather was right this time, 
and the irreverent doctors who laughed at him were 
wrong. One only of their number disputes his claim 
to giving the first impulse to the practice in Boston. 
This is what that person says : — 

"The Small- Pox spread in Boston, New England, 
A. 1721, and the Reverend Dr. Cotton Mather^ having 
had the use of these Communications from Dr. 117/- 
11(1/11 Douglass " (that is, the writer of these words) ; 
" surreptitiously, without the knowledge of his In- 
former, that lie might have the honour of a New fan- 
gled notion, sets an Undaunted Operator to work, and 
in this Country about 290 were inoculated." 6 

All this has not deprived Cotton Mather of the 

• Magnalia, book i. " The Bostonian Ebenezer." 
6 Diss. Concerning Inoculation, p. 2. 



THE MEDICAL PROFESSION IN MASSACHUSETTS. 347 

credit of suggesting, and a bold and intelligent physi- 
cian of the honor of carrying out, the new practice. 
On the twenty-seventh day of June, 1721, Zabdiel 
Boylston of Boston inoculated his only son for small- 
pox, — the first person ever submitted to the operation 
in the New World. The story of the fierce resistance 
to the introduction of the practice ; of how Boylston 
was mobbed, and Mather had a hand-grenade thrown in 
at his window ; of how William Douglass, the Scotch- 
man, "always positive, and sometimes accurate," as 
was neatly said of him, at once depreciated the prac- 
tice and tried to get the credit of suggesting it, and 
how Lawrence Dalhonde, the Frenchman, testified to 
its destructive consequences ; of how Edmund Massey, 
lecturer at St. Albans, preached against sinfully en- 
deavoring to alter the course of nature by presumptu- 
ous interposition, which he would leave to the atheist 
and the scoffer, the heathen and unbeliever, while in 
the face of his sermon, afterwards reprinted in Boston, 
many of our New England clergy stood up boldly in 
defence of the practice, — all this has been told so 
well and so often that I spare you its details. Set this 
good hint of Cotton Mather against that letter of his 
to John Richards, recommending the search after 
witch-marks, and the application of the water-ordeal, 
which means throw your grandmother into the water, 
if she has a mole on her arm ; — if she swims, she is a 
witch and must be hanged ; if she sinks, the Lord have 
mercy on her soul ! 

Thus did America receive this great discovery, des- 
tined to save thousands of lives, via Boston, from the 
hands of one of our own Massachusetts physicians. 

The year 1735 was rendered sadly memorable by 
the epidemic of the terrible disease known as " throat- 



348 MEDICAL ESSAYS. 

distemper," and regarded by many as the same as our 
" diphtheria. " Dr. Holyoke thinks the more general 
use of mercurials in inflammatory complaints dates 
from the time of their employment in this disease, in 
which they were thought to have proved specially use- 
ful. 

At some time in the course of this century medical 
practice had settled down on four remedies as its chief 
reliance. I must repeat an incident which I have re- 
lated in another of these Essays. When Dr. Holyoke, 
nearly seventy years ago, received young Mr. James 
Jackson as his student, he showed him the formidable 
array of bottles, jars, and drawers around his office, 
and then named the four remedies referred to as being 
of more importance than all the rest put together. 
These were Mercury, Antimony, Opium, and Peruvian 
Bark." b I doubt if either of them remembered that, 
nearly seventy years before, in 1730, Dr. William 
Douglass, the disputatious Scotchman, mentioned those 
same four remedies, in the dedication of his quarrel- 
some essay on inoculation, as the most important ones 
in the hands of the physicians of his time. 

In the " Proceedings" of this Society for the year 
1863 is a very pleasant paper by the late Dr. Ephraim 
Eliot, giving an account of the leading physicians of 
Boston during the last quarter of the last century. 
The names of Lloyd, Gardiner, Welsh, Rand, Bulfincli, 
Danforth, John Warren, Jeffries, are all famous in 
local history, and are commemorated in our medical 
biographies. One of them, at least, appears to have 
been more widely known, not only as one of the first 

° Memoir of Edward A. Holyoke y M. D., LL. 2)., p. 64. Bos. 

ton, 1829. 

6 Another Letter to a Young Physician, p. 15. 



THE MEDICAL PROFESSION IN MASSACHUSETTS. 349 

aerial voyagers, but as an explorer in the almost 
equally hazardous realm of medical theory. Dr. John 
Jeffries, the first of that name, is considered by Brous- 
sais as a leader of medical opinion in America, and so 
referred to in his famous " Examen des Doctrines 
Medicales." 

Two great movements took place in this eighteenth 
century, the effect of which has been chiefly felt in our 
own time ; namely, the establishment of the Massachu- 
setts Medical Society, and the founding of the Medical 
School of Harvard University. 

The third century of our medical history began with 
the introduction of the second great medical discovery 
of modern times, — of all time up to that date, I may 
say, — once more via Boston, if we count the Univer- 
sity village as its suburb, and once more by one of 
our Massachusetts physicians. In the month of July, 
1800, Dr. Benjamin Waterhouse of Cambridge sub- 
mitted four of his own children to the new process of 
vaccination, — the first persons vaccinated, as Dr. Zab- 
diel Boylston's son had been the first person inoculated 
in the New World. 

A little before the first half of this century was com- 
pleted, in the autumn of 1846, the great discovery 
went forth from the Massachusetts General Hospital, 
which repaid the debt of America to the science of the 
Old World, and gave immortality to the place of its 
origin in the memory and the heart of mankind. The 
production of temporary insensibility at will — tuto, 
cito, jucunde, safely, quickly, pleasantly — is one of 
those triumphs over the infirmities of our mortal con- 
dition which change the aspect of life ever afterwards. 
Ehetoric can add nothing to its glory ; gratitude, and 



350 MEDICAL ESSAYS. 

the pride permitted to human weakness, that our Beth- 
lehem should have been chosen as the birthplace of 
this new embodiment of the divine mercy, are all we 
can yet find room for. 

The present century has seen the establishment of 
all those great charitable institutions for the cure of 
diseases of the body and of the mind, which our State 
and our city have a right to consider as among the 
chief ornaments of their civilization. 

The last century had very little to show, in our 
State, in the way of medical literature. The worthies 
who took care of our grandfathers and great-grand- 
fathers, like the Revolutionary heroes, fought (with 
disease) and bled (their patients) and died (in spite 
of their own remedies) ; but their names, once famil- 
iar, are heard only at rare intervals. Honored in 
their day, not unreinembered by a few solitary students 
of the past, their memories are going sweetly to sleep 
in the arms of the patient old dry-nurse, whose " black- 
drop" is the never-failing anodyne of the restless gen- 
erations of men. Except the lively controversy on 
inoculation, and floating papers in journals, we have 
not much of value for that long period, in the shape of 
medical records. 

But while the trouble with the last century is to find 
authors to mention, the trouble of this would be to name 
all that we find. Of these, a very few claim unques- 
tioned preeminence. 

Nathan Smith, born in Rehoboth, Mass., a graduate 
of the Medical School of our University, did a great 
work for the advancement of medicine and surgery in 
New England, by his labors as teacher and author, — 
greater, it is claimed by some, than was ever done by 
any other man. The two Warrens, of our time, each 



THE MEDICAL PROFESSION IN MASSACHUSETTS. 351 

left a large and permanent record of a most extended 
surgical practice. James Jackson not only educated a 
whole generation by his lessons of wisdom, but be- 
queathed some of the most valuable results of his ex- 
perience to those who came after him, in a series of 
letters singularly pleasant and kindly as well as in- 
structive. John Ware, keen and cautious, earnest and 
deliberate, wrote the two remarkable essays which have 
identified his name, for all time, with two important 
diseases, on which he has shed new light by his orig- 
inal observations. 

I must do violence to the modesty of the living by 
referring to the many important contributions to medi- 
cal science by Dr. Jacob Bigelow, and especially to 
his discourse on " Self -limited Diseases," an address 
which can be read in a single hour, but the influence 
of which will be felt for a century. 

Nor wordd the profession forgive me if I forgot to 
mention the admirable museum of pathological anat- 
omy, created almost entirely by the hands of Dr. 
John Barnard Swett Jackson, and illustrated by his 
own printed descriptive catalogue, justly spoken of by 
a distinguished professor in the University of Penn- 
sylvania as the most important contribution which had 
ever been made in this country to the branch to which 
it relates. 

When we look at the literature of mental disease, 
as seen in hospital reports and special treatises, we 
can mention the names of Wyman, Woodward, Brig- 
ham, Bell, and Bay, all either natives of Massachusetts 
or placed at the head of her institutions for the treat- 
ment of the insane. 

We have a right to claim also one who is known all 
over the civilized world as a philanthropist, to us as a 



352 MEDICAL ESSAYS. 

townsman and a graduate of our own Medical School, 
Dr. Samuel Gridley Howe, the gTiide and benefactor 
of a great multitude who were born to a world of in- 
ward or of outward darkness. 

I cannot pass over in silence the part taken by our 
own physicians in those sanitary movements which are 
assuming every year greater importance. Two dis- 
eases especially have attracted attention, above all 
others, with reference to their causes and prevention ; 
cholera, the " black death " of the nineteenth century, 
and consumption, the white plague of the North, both of 
which have been faithfully studied and reported on by 
physicians of our own State and city. The cultivation 
of medical and surgical specialties, which is fast becom- 
ing prevalent, is beginning to show its effects in the 
literature of the profession, which is every year grow- 
ing richer in original observations and investigations. 

To these benefactors who have labored for us in 
their peaceful vocation, we must add the noble army of 
surgeons, who went with the soldiers who fought the 
battles of their country, sharing many of their dan- 
gers, not rarely falling victims to fatigue, disease, or 
the deadly volleys to which they often exposed them- 
selves in the discharge of their duties. 

The pleasant biographies of the venerable Dr. 
Thacher, and the worthy and kind-hearted gleaner, 
Dr. Stephen W. Williams, who came after him, are 
filled with the names of men who served their £ener- 
ation well, and rest from their labors, followed by the 
blessing of those for whom they endured the toils and 
fatigues inseparable from their calling. The hard- 
working, intelligent country physician more especially 
deserves the gratitude of his own generation, for he 
rarely leaves any permanent record in the literature 



THE MEDICAL PROFESSION IN MASSACHUSETTS. 353 

of his profession. Books are hard to obtain ; hospitals, 
which are always centres of intelligence, are remote ; 
thoroughly educated and superior men are separated 
by wide intervals ; and long rides, though favorable to 
reflection, take up much of the time which might other- 
wise be given to the labors of the stmly. So it is that 
men of ability and vast experience, like the late Dr. 
Twitchell, for instance, make a great and deserved rep- 
utation, become the oracles of large districts, and yet 
leave nothing, or next to nothing, by which their names 
shall be preserved from blank oblivion. 

One or two other facts deserve mention, as showing 
the readiness of our medical community to receive and 
adopt any important idea or discovery. The new sci- 
ence of Histology, as it is now called, was first brought 
fully before the profession of this country by the trans- 
lation of Bichat's great work, " Anatomie Generale," 
by the late Dr. George Hayward. 

The first work printed in this country on Auscul- 
tation, — that wonderful art of discovering disease, 
which, as it were, puts a window in the breast, through 
which the vital organs can be seen, to all intents and 
purposes, — was the manual published anonymously by 
" A Member of the Massachusetts Medical Society." 

We are now in some slight measure prepared to 
weigh the record of the medical profession in Massa- 
chusetts, and pass our judgment upon it. But in order 
to do justice to the first generation of practitioners, 
we must compare what we know of their treatment of 
disease with the state of the art in England, and the 
superstitions which they saw all around them in other 
departments of knowledge or belief. 

English medical literature must have been at a 

23 



354 MEDICAL ESSAYS. 

pretty low ebb when Sydenham recommended Don 
Quixote to Sir Richard Blackmore for professional 
reading. The College Pharmacopoeia was loaded with 
the most absurd compound mixtures, one of the most 
complex of which (the same which the Reverend Mr. 
Harward, " Lecturer at the Royal Chappel in Boston," 
tried to simplify) was not dropped until the year 1801. 
Sir Kenelm Digby was playing his fantastic tricks with 
the Sympathetic powder, and teaching Governor Win- 
throp, the second, how to cure fever and ague, which 
some may like to know. Pare the patient's nails ; put 
the parings in a little bag, and hang the bag round the 
neck of a live eel, and put him in a tub of water. 
The eel will die, and the patient will recover. 

Wiseman, the great surgeon, was discoursing elo- 
quently on the efficacy of the royal touch in scrofula. 6 
The founder of the Ashmolean Museum at Oxford, 
consorting with alchemists and astrologers, was treas- 
uring the manuscripts of the late pious Dr. Richard 
Napier, in which certain letters (ty Ris) were under- 
stood to mean Responsum Raphaelis, — the answer of 
the angel Raphael to the good man's medical ques- 
tions/ The illustrious Robert Boyle was making his 
collection of choice and safe remedies, including the 
sole of an old shoe, d the thigh bone of a hanged 
man/ and things far worse than these, as articles of 
his materia medica. Dr. Stafford, whose paper of 
directions to his " friend, Mr. Wintrop," I cited, was 

■ Hist. Coll. 3d Serfcs, vol. x. 

b Several ChirurgkaU Treatises, p. 24 5. London, 16 76. 

e Turner (William), Remarkable Providences, part i. chap. 2. 
Also referred to in Mother's MS., The Angel of Bethesda. 

d Medicinal Experiments, p. 105. 5th edition. London, 
1712. 

" Ibid. p. 105. 



THE MEDICAL PROFESSION IN MASSACHUSETTS. 355 

probably a man of standing in London ; yet toad- 
powder was his sovereign remedy. 

See what was the state of belief in other matters 
among the most intelligent persons of the colonies, — 
magistrates and clergymen. Jonathan Brewster, son 
of the church-elder, writes the wildest letters to John 
Winthrop about alchemy, — mad for making gold as 
the Lynn rock-borers are for finding it. a 

Remember the theology and the diabology of the 
time. Mr. Cotton's Theocracy was a royal govern- 
ment, with the King of kings as its nominal head, but 
with an upper chamber of saints, and a tremendous 
opposition in the lower house ; the leader of which 
may have been equalled, but cannot have been sur- 
passed by any of our earth-born politicians. The de- 
mons were prowling round the houses every night, as 
the foxes were sneaking about the hen-roosts. The 
men of Gloucester fired whole flasks of gunpowder at 
devils disguised as Indians and Frenchmen. 6 

How deeply the notion of miraculous interference 
with the course of nature was rooted, is shown by the 
tenacity of the superstition about earthquakes. We 
can hardly believe that our Professor Winthrop, father 
of the old judge and the " squire," whom many of us 
Cambridge people remember so well, had to defend 
himself against the learned and excellent Dr. Prince, 
of the Old South Church, for discussing their phenom- 
ena as if they belonged to the province of natural sci- 
ence. 

Not for the sake of degrading the aspect of the 
noble men who founded our State, do I refer to their 

" Hist. Coll. 4th Series, vol. vii. pp. 72, 77. 

6 Magnalia, book vii. art. 18. 

Two Lectures on Cornets^ p. vii. Boston, 1811. 



356 MEDICAL ESSAYS. 

idle beliefs and painful delusions, but to show against 
what influences the common sense of the medical pro- 
fession had to assert itself. 

Think, then, of the blazing stars, that shook their 
horrid hair in the sky ; the phantom ship, that brought 
its message direct from the other world ; a the story of 
the mouse and the snake at Watertown ; b of the mice 
and the prayer-book ; c of the snake in church ; d of 
the calf with two heads ; e and of the cabbage " in the 
perfect form of a cutlash," 7 — all which innocent oc- 
currences were accepted or feared as alarming por- 
tents. 

We can smile at these : but we cannot smile at the 
account of unhappy Mary Dyer's malformed offspring ; ° 
or of Mrs. Hutchinson's domestic misfortune of similar 
character,* in the story of which the physician, Dr. 
John Clark of Rhode Island, alone appears to advan- 
tage ; or as we read the Rev. Samuel Willard's fifteen 
alarming pages about an unfortunate young woman 
suffering with hysteria. 1 Or go a little deeper into 
tragedy, and see poor Dorothy Talby, mad as Ophelia, 
first admonished, then whipped ; at last, taking her 
own little daughter's life ; put on trial, and standing 
mute, threatened to be pressed to death, confessing, 

° Magnalia, book i. chap. 6. Winthrop, Hist, of N. E. vol. 
ii. p. 328. 

6 Life and Letters of John Winthrop, p. 108. 
e Winthrop, Hist, of N. E. vol. ii. p. 20. 

* Ibid. vol. ii. p. 330. 

* Mather Papers in Hist. Soc. Coll. 4th Series, vol. viii. p. 
614. 

f Ibid. ° Winthrop, Hist. ofN. E. vol. i. p. 261. 

h Winthrop, Hist ofN. E. p. 271. 

* Case of Elizabeth Knapp, Hist. Coll. 4th Series, vol. viii. 
p. 555. 



THE MEDICAL PROFESSION IN MASSACHUSETTS. 357 

sentenced, praying to be beheaded ; and none the less 
pitilessly swung from the fatal ladder." 

The cooper's crazy wife — crazy in the belief that 
she has committed the unpardonable sin — tries to 
drown her child, to save it from misery ; and the poor 
lunatic, who would be tenderly cared for to-day in a 
quiet asylum, is judged to be acting under the instiga- 
tion of Satan himself. 6 Yet, after all, what can we 
say, who put Bunyan's " Pilgrim's Progress," full of 
nightmare dreams of horror, into all our children's 
hands ; a story in which the awful image of the man 
in the cage might well turn the nursery where it is 
read into a madhouse ? 

The miserable delusion of witchcraft illustrates, in a 
still more impressive way, the false ideas which gov- 
erned the supposed relation of men with the spiritual 
world. I have no doubt many physicians shared in 
these superstitions. Mr. Upham says they — that is, 
some of them — were in the habit of attributing their 
want of success to the fact, that an " evil hand " was 
on their patient. The temptation was strong, no 
doubt, when magistrates and ministers and all that 
followed their lead were contented with such an expla- 
nation. But how was it in Salem, according to Mr. 
Upham' s own statement ? Dr. John Swinnerton was, 
he says, for many years the principal physician of 
Salem. d And he says, also, " The Swinnerton family 
were all along opposed to Mr. Parris, and kept re- 
markably clear from the witchcraft delusion." e Dr. 
John Swinnerton — the same, by the way, whose mem* 

a Winthrop, Hist, of N. E. vol. i. p. 279. 

6 Ibid. vol. ii. p. 65. 

e Salem Witchcraft, vol. ii. p. 361. Boston, 1867. 

d Ibid. vol. i. p. 140. 

' Ibid. vol. ii. p. 495 (Supplement). 



358 MEDICAL ESSAYS. 

ory is illuminated by a ray from the genius of Haw- 
thorne — died the very year before the great witch- 
craft explosion took place. But who can doubt that it 
was from him that the family had learned to despise 
and to resist the base superstition; or that Bridget 
Bishop, whose house he rented, as Mr. Upham tells 
me, the first person hanged in the time of the delusion, 
would have found an efficient protector in her tenant, 
had he been living, to head the opposition of his fam- 
ily to the misguided clergymen and magistrates ? 

I cannot doubt that our early physicians brought 
with them many Old- World medical superstitions, and 
I have no question that they were more or less involved 
in the prevailing errors of the community in which 
they lived. But, on the whole, their record is a clean 
one, so far as we can get at it ; and where it is ques- 
tionable we must remember that there must have been 
many little-educated persons among them ; and that 
all must have felt, to some extent, the influence of 
those sincere and devoted but unsafe men, the physic- 
practising clergymen, who often used spiritual means 
as a substitute for temporal ones, who looked upon a 
hysteric patient as possessed by the devil, and treated 
a fractured skull by prayers and plasters, following the 
advice of a ruling elder in opposition to the unani- 
mous opinion of seven surgeons. 

To what results the union of the two professions 
was liable to lead, may be seen by the example of a 
learned and famous person, who has left on record the 
product of his labors in the double capacity of clergy- 
man and physician. 

I have had the privilege of examining a manuscript 
of Cotton Mather's relating to medicine, by the kind- 

° Winthrop's History, vol. ii. p. 203. The child recovered. 



THE MEDICAL PROFESSION IN MASSACHUSETTS. 359 

ness of the librarian of the American Antiquarian So- 
ciet} r , to which society it belongs. A brief notice of 
this curious document may prove not uninteresting'. 

It is entitled " The Angel of Bethesda : an Essay 
upon the Common Maladies of Mankind, offering, 
first, the sentiments of Piety," etc., etc., and " a col- 
lection of plain but potent and Approved Remedies 
for the Maladies." There are sixty-six " Capsula's," 
as he calls them, or chapters, in his table of contents ; 
of which, five — from the fifteenth to the nineteenth, 
inclusive — are missing. This is a most unfortunate 
loss, as the eighteenth capsula treated of agues, and 
we could have learned from it something of their de- 
gree of frequency in this part of New England. There 
is no date to the manuscript ; which, however, refers 
to a case observed Nov. 14, 1724. 

The divine takes precedence of the physician in this 
extraordinary production. He begins by preaching a 
sermon at his unfortunate patient. Having thrown 
him into a' cold sweat by his spiritual sudorific, he at- 
tacks him with his material remedies, which are often 
quite as unpalatable. The simple and cleanly practice 
of Sydenham, with whose works he was acquainted, 
seems to have been thrown away upon him. Every- 
thing he could find mentioned in the seventy or eighty 
authors he cites, all that the old women of both sexes 
had ever told him of, gets into his text, or squeezes it- 
self into his margin. 

Evolving disease out of sin, he hates it, one would 
say, as he hates its cause, and would drive it out of the 
body with all noisome appliances. " Sickness is in 
Fact Flagelhim Dei pro peccatis mundi." So saying, 
he encourages the young mother whose babe is wasting 
away upon her breast with these reflections : — 



360 MEDICAL ESSAYS. 

"Think; oh the grievous Effects of Sin! This 
wretched Infant has not arrived unto years of sense 
enough, to sin after the similitude of the transgres- 
sion committed by Adam. Nevertheless the Trans- 
gression of Adam, who had all mankind Foederalltj, 
yea, Naturally, in him, has involved this Infant in the 
guilt of it. And the poison of the old serpent, which 
infected Adam when he fell into his Transgression, 
by hearkening to the Tempter, has corrupted all man- 
kind, and is a seed unto such diseases as this Infant is 
now laboring under. Lord, what are we, and what 
are our children, but a Generation of Vipers ? " 

Many of his remedies are at least harmless, but his 
pedantry and utter want of judgment betray them- 
selves everywhere. He piles his prescriptions one 
upon another, without the least discrimination. He is 
run away with by all sorts of fancies and superstitions. 
He prescribes euphrasia, eyebright, for disease of the 
eyes ; appealing confidently to the strange old doctrine 
of signatures, which inferred its use from the resem- 
blance of its flower to the organ of vision. For the 
scattering of wens, " the efficacy of a Dead Hand has 
been out of measure wonderful." But when he once 
comes to the odious class of remedies, he revels in them 
like a scarabeus. This allusion will bring us quite 
near enough to the inconceivable abominations with 
which he proposed to outrage the sinful stomachs of 
the unhappy confederates and accomplices of Adam. 

It is well that the treatise was never printed, vet 
there are passages in it worth preserving. He sj)eaks 
of some remedies which have since become more uni- 
versally known : — 

" Among the plants of our soyl, Sir William Tem- 
ple singles out Five [Six] as being of the greatest virtue 



THE MEDICAL PROFESSION IN MASSACHUSETTS. 361 

and most friendly to health : and his favorite plants, 
Sage, Rue, Saffron, Alehoof, Gar lick, and Elder." 

" But these Five [Six] plants may admitt of some 
competitors. The Quinquina — How celebrated : Im- 
moderately, Hyperbolically celebrated ! " 

Of Ipecacuanha, he says, — 

"This is now in its reign; the most fashionable 
vomit." 

" I am not sorry that antimonial emetics begin to be 
disused." 

He quotes " Mr. Lock " as recommending red pop- 
py-water and abstinence from flesh as often useful in 
children's diseases. 

One of his " Capsula's " is devoted to the animal- 
cular origin of diseases, at the end of which he says, 
speaking of remedies for this supposed source of our 
distempers : — 

" Mercury we know thee : But we are afraid thou 
wilt kill us too, if we employ thee to kill them that 
kill us. 

" And yett, for the cleansing of the small Blood Ves- 
sels, and making way for the free circulation of the 
Blood and Lymph — there is nothing like Mercurial 
Deobstruents." 

From this we learn that mercury was already in com- 
mon use, and the subject of the same popular prejudice 
as in our own time. 

His poetical turn shows itself here and there : — 

" O Nightingale, with a Thorn at thy Breast ; Under 
the trouble of a Cough, what can be more proper than 
such thoughts as these ? " . . . 

If there is pathos in this, there is bathos in his apos- 
trophe to the millipede, beginning " Poor sowbug ! " 
and eulogizing the healing virtues of that odious little 



362 MEDICAL ESSAYS. 

beast ; of which he tells us to take " half a pound, 
putt 'em alive into a quart or two of wine," with saf- 
fron and other drugs, and take two ounces twice a day. 

The " Capsula " entitled " Nishmath Chajim " was 
printed in 1722, at New London, and is in the posses- 
sion of our own Society. . He means, by these words, 
something like the Archa3us of Van Helmont, of which 
he discourses in a style wonderfully resembling that of 
Mr. Jenkinson in the " Vicar of Wakefield." " Many 
of the Ancients thought there was much of a Real 
History in the Parable, and their Opinion was that 
there is, Diapkora kata tas Morphas, A Distinc- 
tion (and so a Resemblance) of men as to their Shapes 
after Death" And so on, with Irenaeus, Tertullian, 
Thespesius, and " the Ta Tone Pseucone cromata," 
in the place of " Sanconiathon, Manetko, Berosus" 
and " Anarchon ara kai ateleutaion to pan." 

One other passage deserves notice, as it relates 
to the single medical suggestion which does honor to 
Cotton Mather's memory. It does not appear that he 
availed himself of the information which he says he 
obtained from his slave, for such I suppose he was. 

In his appendix to " Variola? Triumphatae," he 
says, — 

"There has been a wonderful practice lately used 
in several parts of the world, which indeed is not yet 
become common in our nation. 

" I was first informed of it by a Garamantee servant 
of my own, long before I knew that any Europeans 
or A si (t ticks had the least acquaintance with it, and 
some years before I was enriched with the communica- 
tions of the learned Foreigners, whose accounts I found 
agreeing with what I received of my servant, when he 
shewed me the Scar of the Wound made for the opera* 



THE MEDICAL PROFESSION IN MASSACHUSETTS. 363 

tion ; and said, That no person ever died of the small- 
pox, in their conn trey, that had the courage to use it. 

" I have since met with a considerable Number of 
these Africans, who all agree in one story ; That in 
their countrey grandy-many dy of the small-pox : But 
now they learn this way : people take juice of small- 
pox and cutty-shin and put in a Drop ; then by 'nd by 
a little sicky, sicky: then very few little things like 
small-pox ; and nobody dy of it ; and nobody have 
small-pox any more. Thus, in Africa, where the poor 
creatures dy of the small-pox like Rotten Sheep, a 
merciful God has taught them an Infallible preserva- 
tive. 'T is a common practice, and is attended with a 
constant success.^ 

What has come down to us of the first century of 
medical practice, in the hands of Winthrop and Oliver, 
is comparatively, simple and reasonable. I suspect 
that the conditions of rude, stern life, in which the 
colonists found themselves in the wilderness, took the 
nonsense out of them, as the exigencies of a campaign 
did out of our physicians and surgeons in the late war. 
Good food and enough of it, pure air and water, clean- 
liness, good attendance, an anaesthetic, an opiate, a 
stimulant, quinine, and two or three common drugs, 
proved to be the marrow of medical treatment ; and 
the fopperies of the pharmacopoeia went the way of 
embroidered shirts and white kid gloves and malacca 
joints, in their time of need. " Good wine is the best 
corcliall for her," said Governor John Winthrop, Jun- 
ior, to Samuel Symonds, speaking of that gentleman's 
wife, — just as Sydenham, instead of physic, once or- 
dered a roast chicken and a pint of canary for his 
patient in male hysterics. 

But the profession of medicine never could reach its 



364 MEDICAL ESSAYS. 

full development until it became entirely separated 
from that of divinity. The spiritual guide, the con- 
soler in affliction, the confessor who is admitted into 
the secrets of our souls, has his own noble sphere of 
duties ; but the healer of men must confine himself 
solely to the revelations of God in nature, as he sees 
their miracles with his own eyes. No doctrine of 
prayer or special providence is to be his excuse for not 
looking straight at secondary causes, and acting, exactly 
so far as experience justifies him, as if he were him- 
self the divine agent which antiquity fabled him to be. 
While pious men were praying — humbly, sincerely, 
rightly, according to their knowledge — over the end- 
less succession of little children dying of spasms in the 
great Dublin Hospital, a sagacious physician knocked 
some holes in the walls of the ward, let God's blessed 
air in on the little creatures, and so had already saved 
in that single hospital, as it was soberly calculated 
thirty years ago, more than sixteen thousand lives of 
these infant heirs of immortality." 

Let it be, if you will, that the wise inspiration of the 
physician was granted in virtue of the clergyman's sup- 
plications. Still, the habit of dealing with things 
seen generates another kind of knowledge, and an- 
other way of thought, from that of dealing with tilings 
unseen ; which knowledge and way of thought are 
special means granted by Providence, and to be thank- 
fully accepted. 

The mediaeval ecclesiastics expressed a great truth 
in that saying, so often quoted, as carrying a reproach 
with it: " Ubi trcs medici, duo athei," — "Where 
there are three physicians, there are two. atheists." 

° Collins's Midwifery, p. 312. Published by order of the 
Massachusetts Medical Society. Boston, 1841. 



THE MEDICAL PROFESSION IN MASSACHUSETTS. 365 

It was true then, it is true to-day, that the physician 
very commonly, if not very generally, denies and repu- 
diates the deity of ecclesiastical commerce. The Being 
whom Ambroise Pare meant when he spoke those memo- 
rable words, which you may read over the professor's 
chair in the French School of Medicine, — " Je le pen- 
say, et Dieu le guarit" — "I dressed his wound, and 
God healed it," — is a different being from the God that 
scholastic theologians have projected from their con- 
sciousness, or shaped even from the sacred pages which 
have proved so plastic in their hands. He is a God 
who never leaves himself without witness, who repent- 
eth him of the evil, who never allows a disease or an 
injury, compatible with the enjoyment of life, to take 
its course without establishing an effort, limited by 
certain fixed conditions, it is true, but an effort, always, 
to restore the broken body or the shattered mind. In 
the perpetual presence of this great Healing Agent, 
who stays the bleeding of wounds, who knits the frac- 
tured bone, who expels the splinter by a gentle natural 
process, who walls in the inflammation that might in- 
volve the vital organs, who draws a cordon to separate 
the dead part from the living, who sends his three 
natural anaesthetics to the overtasked frame in due 
order, according to its need, — sleep, fainting, death ; 
in this perpetual presence, it is doubtless hard for the 
physician to realize the theological fact of a vast and 
permanent sphere of the universe, where no organ finds 
itself in its natural medium, where no wound heals 
kindly, where the executive has abrogated the pardon- 
ing power, and mercy forgets its errand; where the 
omnipotent is unfelt save in malignant agencies, and 
the omnipresent is unseen and unrepresented ; hard to 
accept the God of Dante's " Inferno," and of Bunyan's 



366 MEDICAL ESSAYS. 

caged lunatic. If this is atheism, call three, instead 
of two of the trio, atheists, and it will probably come 
nearer the truth. 

I am not disposed to deny the occasional injurious 
effect of the materializing' influences to which the phy- 
sician is subjected. A spiritual guild is absolutely 
necessary to keep him, to keep us all, from becoming 
the " fingering slaves " that Wordsworth treats with 
such shrivelling scorn. But it is well that the two 
callings have been separated, and it is fitting that they 
remain apart. In settling the affairs of the late con- 
cern, I am afraid our good friends remain a little in 
our debt. We lent them our physician Michael Ser- 
vetus in fair condition, and they returned him so dam- 
aged by fire as to be quite useless for our purposes. 
Their Reverend Samuel Willard wrote us a not over- 
wise report of a case of hysteria ; and our Jean Astruc 
gave them (if we may trust Dr. Smith's Dictionary of 
the Bible) the first discerning criticism on the author- 
ship of the Pentateuch. Our John Locke enlightened 
them with his letters concerning toleration ; and their 
Cotton Mather obscured our twilight with his " Nish- 
math Chajim." 

Yet we must remember that the name of Basil Val- 
entine, the monk, is associated with whatever good and 
harm we can ascribe to antimony ,• and that the most 
remarkable of our specifics long bore the name of 
44 Jesuit's Bark," from an old legend connected with 
its introduction. " Frere Jacques," who taught the 
lithotomists of Paris, owes his ecclesiastical title to 
courtesy, as he did not belong to a religious order. 

Medical science, and especially the study of mental 
disease, is destined, I believe, to react to much greater 
advantage on the theology of the future than theology 



THE MEDICAL PROFESSION IN MASSACHUSETTS. 367 

has acted on medicine in the past. The liberal spirit 
very generally prevailing in both professions, and the 
good understanding between their most enlightened 
members, promise well for the future of both in a com- 
munity which holds every point of human belief, 
every institution in human hands, and every word 
written in a human dialect, open to free discussion to- 
day, to-morrow, and to the end of time. Whether the 
world at large will ever be cured of trusting to spe- 
cifics as a substitute for observing the laws of health, 
and to mechanical or intellectual formulae as a substi- 
tute for character, may admit of question. Quackery, 
and idolatry are all but immortal. 

We can find most of the old beliefs alive amongst 
us to-day, only having changed their dresses and the 
social spheres in which they thrive. We think the 
quarrels of Galenists and chemists belong to the past, 
forgetting that Thomsonism has its numerous apostles 
in our community ; that it is common to see remedies 
vaunted as purely vegetable, and that the prejudice 
against " mineral poisons," especially mercury, is as 
strong in many quarters now as it was at the begin- 
ning of the seventeenth century. Names are only air, 
and blow away with a change of wind ; but beliefs are 
rooted in human wants and weakness, and die hard. 
The oaks of Dodona are prostrate, and the shrine of 
Delphi is desolate ; but the Pythoness and the Sibyl 
may be consulted in Lowell Street for a very moderate 
compensation. Nostradamus and Lilly seem impossi- 
ble in our time ; but we have seen the advertisements 
of an astrologer in our Boston papers year after year, 
which seems to imply that he found believers and pa- 
trons. You smiled when I related Sir Kenelm Digby's 
prescription with the live eel in it ; but if each of you 



368 MEDICAL ESSAYS. 

were to empty his or her pockets, would there not roll 
out, from more than one of them, a horse-chestnut, car- 
ried about as a cure for rheumatism ? The brazen 
head of Roger Bacon is mute : but is not " Plan- 
chette " uttering her responses in a hundred houses of 
this city ? We think of palmistry or chiromancy as 
belonging to the days of Albertus Magnus, or, if exist- 
ing in our time, as given over to the gypsies ; but a 
very distinguished person has recently shown me the 
line of life, and the line of fortune, on the palm of his 
hand, with a seeming confidence in the sanguine pre- 
dictions of his career which had been drawn from 
them. What shall we say of the plausible and well- 
dressed charlatans of our own time, who trade in false 
pretences, like Nicholas Knapp of old, but without any 
fear of being fined or whipped ; or of the many follies 
and inanities, imposing on the credulous part of the 
community, each of them gaping with eager, open 
mouth for a gratuitous advertisement by the mention 
of its foolish name in any respectable connection ? 

I turn from this less pleasing aspect of the common 
intelligence which renders such follies possible, to close 
the honorable record of the medical profession in this, 
our ancient Commonwealth. 

We have seen it in the first century divided among 
clergymen, magistrates, and regular practitioners ; yet, 
on the whole, for the time, and under the circum- 
stances, respectable, except where it invoked supernat- 
ural agencies to account for natural phenomena. 

In the second century it simplified its practice, edu- 
cated many intelligent practitioners, and began the 
work of organizing for concerted action, and for medi- 
cal teaching. 

In this, our own century, it has built hospitals, per- 



THE MEDICAL PROFESSION IN MASSxVCHUSETTS. 369 

fected and multiplied its associations and educational 
institutions, enlarged and created museums, and chal- 
lenged a place in the world of science by its literature. 
In reviewing the whole course of its history we read 
a long list of honored names, and a precious record 
written in private memories, in public charities, in 
permanent contributions to medical science, in gener- 
ous sacrifices for the country. We can point to our 
capital as the port of entry for the New World of the 
great medical discoveries of two successive centuries, 
and we can claim for it the triumph over the most 
dreaded foe that assails the human body, — a triumph 
which the annals of the race can hardly match in three 
thousand years of medical history. 
24 



VII. 
THE YOUNG PRACTITIONER. 3 

The occasion which calls us together reminds us 
not a little of that other ceremony which unites a man 
ami woman for life. The banns have already been 
pronounced which have wedded our young friends to 
the profession of their choice. It remains only to ad- 
dress to them some friendly words of cheering coun- 
sel, and to bestow upon them the parting benediction. 

This is not the time for rhetorical display or ambi- 
tious eloquence. We must forget ourselves, and think 
only of them. To us it is an occasion ; to them it is 
an epoch. The spectators at the wedding look curi- 
ously at the bride and bridegroom ; at the bridal veil, 
the orange-flower garland, the giving and receiving of 
the ring; they listen for the tremulous " I will," and 
wonder what are the mysterious syllables the clergy- 
man whispers in the ear of the married maiden. But 
to the newly-wedded pair what meaning in those 
words, " for better, for worse," " in sickness and in 
health," " till death us do part ! " To the father, to 
the mother, who know too well how often the deadly 
nightshade is interwoven with the wreath of orange- 
blossoms, how empty the pageant, how momentous the 
reality ! 

You will not wonder that I address myself chiefly to 

° A Valedit-tory Address delivered to the Graduating Class of 
the Bellevue Hospital College, March 2, 1871. 



THE YOUNG PRACTITIONER. 371 

those who are just leaving academic life for the sterner 
struggle and the larger tasks of matured and in- 
structed manhood. The hour belongs to them ; if oth- 
ers find patience to listen, they will kindly remember 
that, after all, they are but as the spectators at the 
wedding, and that the priest is thinking less of them 
than of their friends who are kneeling at the altar. 

I speak more directly to you, then, gentlemen of the 
graduating class. The days of your education, as pu- 
pils of trained instructors, are over. Your first har- 
vest is all garnered. Henceforth you are to be sowers 
as well as reapers, and your field is the world. How 
does your knowledge stand to-day ? What have you 
gained as a permanent possession ? What must you 
expect to forget ? What remains for you yet to learn ? 
These are questions which it may interest you to con- 
sider. 

There is another question which must force itself 
on the thoughts of many among you : " How am I to 
obtain patients and to keep their confidence ? " You 
have chosen a laborious calling, and made many sacri- 
fices to fit yourselves for its successful pursuit. You 
wish to be employed that you may be useful, and that 
you may receive the reward of your industry. I would 
take advantage of these most receptive moments to 
give you some hints which may help you to realize 
your hopes and expectations. Such is the outline of 
the familiar talk I shall offer you. 

Your acquaintance with some of the accessory 
branches is probably greater now than it will be in a 
year from now, — much greater than it will be ten 
years from now. The progress of knowledge, it may 
be feared, or hoped, will have outrun the text-books in 
which you studied these branches. Chemistry, for in- 



372 MEDICAL ESSAYS. 

stance, is very apt to spoil on one's hands. "Nous 
avons change tout celd " might serve as the standing 
motto of many of our manuals. Science is a great 
traveller, and wears her shoes out pretty fast, as might 
be expected. 

You are now fresh from the lecture-room and the 
laboratory. You can pass an examination in anatomy, 
physiology, chemistry, materia medica, which the men 
in large practice all around you would find a more po- 
tent sudorific than any in the Pharmacopoeia. These 
masters of the art of healing were once as ready with 
their answers as you are now, but they have got rid of 
a great deal of the less immediately practical part of 
their acquisitions, and you must undergo the same de- 
pleting process. Hard work will train it off, as sharp 
exercise trains off the fat of a prize-fighter. 

Yet, pause a moment before you infer that your 
teachers must have been in fault when they furnished 
you with mental stores not directly convertible to 
practical purposes, and likely in a few years to lose 
their place in your memory. All systematic knowl- 
edge involves much that is not practical, yet it is the 
only kind of knowledge which satisfies the mind, and 
systematic study proves, in the long-run, the easiest 
way of acquiring and retaining facts which are prac- 
tical. There are many things which we can afford to 
forget, which yet it was well to learn. Your men- 
tal condition is not the same as if you had never known 
what you now try in vain to recall. There is a per- 
petual metempsychosis of thought, and the knowledge 
of to-day finds a soil in the forgotten facts of yester- 
day. You cannot see anything in the new season of 
the guano you placed last year about the roots of your 
climbing plants, but it is blushing and breathing fra- 



THE YOUNG PRACTITIONER. 373 

grance in your trellised roses ; it has scaled your porch 
in the bee-haunted honey-suckle ; it has found its way 
where the ivy is green ; it is gone where the woodbine 
expands its luxuriant foliage. 

Your diploma seems very broad to-day with your list 
of accomplishments, but it begins to shrink from this 
hour like the Peau de Chagrin of Balzac's story. 
Do not worry about it, for all the while there will be 
making out for you an ampler and fairer parchment, 
signed by oil Father Time himself as President of 
that great University in which experience is the one 
perpetual and all-sufficient professor. 

Your present plethora of acquirements will soon 
cure itself. Knowledge that is not wanted dies out 
like the eyes of the fishes of the Mammoth Cave. 
When you come to handle life and death as your 
daily business, } r our memory will of itself bid good-by 
to such inmates as the well-known foramina of the 
sphenoid bone and the familiar oxides of methyl-ethyl- 
amyl-phenyl-ammonium. Be thankful that you have 
once known them, and remember that even the learned 
ignorance of a nomenclature is something to have mas- 
tered, and may furnish pegs to hang facts upon which 
would otherwise have strewed the floor of memory in 
loose disorder. 

But your education has, after all, been very largely 
practical. You have studied medicine and surgery, 
not chiefly in books, but at the bedside and in the 
operating amphitheatre. It is the sj>ecial advantage 
of large cities that they afford the opportunity of see- 
ing a great deal of disease in a short space of time, 
and of seeing many cases of the same kind of disease 
brought together. Let us not be unjust to the claims 
of the schools remote from the larger centres of "popu- 



374 MEDICAL ESSAYS. 

lation. Who among us has taught better than Nathan 
Smith, better than Elisha Bartlett ? who teaches better 
than some of our living contemporaries who divide 
their time between city and country schools ? I am 
afraid we do not always do justice to our country 
brethren, whose merits are less conspicuously exhibited 
than those of the great city physicians and surgeons, 
such especially as have charge of large hospitals. There 
are modest practitioners living in remote rural districts 
who are gifted by nature with such sagacity and wis- 
dom, trained so well in what is most essential to the 
practice of their art, taught so thoroughly by varied 
experience, forced to such manly self-reliance by their 
comparative isolation, that, from converse with them 
alone, from riding with them on their long rounds as 
they pass from village to village, from talking over 
cases with them, putting up their prescriptions, watch- 
ing their expedients, listening to their cautions, mark- 
ing the event of their predictions, hearing them tell of 
their mistakes, and now and then glory a little in the 
detection of another's blunder, a young man would find 
himself better fitted for his real work than many who 
have followed long courses of lectures and passed a 
showy examination. But the young man is exception- 
ally fortunate who enjoys the intimacy of such a teacher. 
And it must be confessed that the great hospitals, in- 
firmaries, and dispensaries of large cities, where men 
of well-sifted reputations are in constant attendance, 
are the true centres of medical education. No stu- 
dents, I believe, are more thoroughly aware of this 
than those who have graduated at this institution. 
Here, as in all our larger city schools, the greatest 
pains are taken to teach tilings as well as names. 
You have entered into the inheritance of a vast amount 



THE YOUNG PRACTITIONER. 375 

of transmitted skill and wisdom, which you have taken, 
warm, as it were, with the life of your well-schooled in- 
structors. You have not learned all that art has to teach 
you, but you are safer practitioners to-day than were 
many of those whose names we hardly mention without 
a genuflection. I had rather be cared for in a fever by 
the best-taught among you than by the renowned Ferne- 
lius or the illustrious Boerhaave, could they come back 
to us from that better world where there are no physi- 
cians needed, and, if the old adage can be trusted, not 
many within call. I had rather have one of you exer- 
cise his surgical skill upon me than find myself in the 
hands of a resuscitated Fabricius Hildanus, or even of 
a wise Ambroise Pare, revisiting earth in the light of 
the nineteenth century. 

You will not accuse me of underrating your accom- 
plishments. You know what to do for a child in a fit, 
for an alderman in an apoplexy, for a girl that has 
fainted, for a woman in hysterics, for a leg that is 
broken, for an arm that is out of joint, for fevers of 
every color, for the sailor's rheumatism, and the tail- 
or's cachexy. In fact you do really know so much at 
this very hour, that nothing but the searching test of 
time can fully teach you the limitations of your knowl- 
edge. 

Of some of these you will permit me to remind you. 
You will never have outgrown the possibility of new 
acquisitions, for Nature is endless in her variety. But 
even the knowledge which you may be said to possess 
will be a different thing: after lono- habit has made it a 
part of your existence. The t actus eruditus extends 
to the mind as well as to the finger-ends. Experience 
means the knowledge gained by habitual trial, and an 
expert is one who has been in the habit of trying. This 



376 MEDICAL ESSAYS. 

is the idiid of knowledge that made Ulysses wise in the 
ways of men. Many cities had he seen, and known 
the minds of those who dwelt in them. This knowl- 
edge it was that Chaucer's Shipman brought home 
with him from the sea : 

" In many a tempest had his berd be shake." 

This is the knowledge we place most confidence in, in 
the practical affairs of life. 

Our training has two stages. The first stage deals 
with our intelligence, which takes the idea of what is 
to be done with the most charming ease and readiness. 
Let it be a game of billiards, for instance, which the 
marker is going to teach us. We have nothing to do 
but to make this ball glance from that ball and hit 
that other ball, and to knock that ball with this ball 
into a certain caecal sacculus or diverticulum which 
our professional friend calls a pocket. Nothing can 
be clearer ; it is as easy as " playing upon this pipe," 
for which Hamlet gives Guildenstern such lucid direc- 
tions. But this intelligent Me, who steps forward as 
the senior partner in our dual personality, turns out to 
be a terrible bungler. He misses those glancing hits 
which the hard-featured young professional person 
calls " carroms," and insists on pocketing his own ball 
instead of the other one. 

It is the unintelligent J/e, stupid as an idiot, that 
has to try a thing a thousand times before he can do 
it, and then never knows how he does it, that at last 
does it well. We have to educate ourselves through 
the pretentious claims of intellect, into the humble 
accuracy of instinct, and we end at last by acquiring 
the dexterit} 7 , the perfection, the certainty, which those 
masters of arts, the bee and the spider, inherit from 
Nature. 



THE YOUNG PRACTITIONER. 377 

Book-knowledge, lecture-knowledge, examination- 
knowledge, are all in the brain. But work-knowledge 
is not only in the brain, it is in the senses, in the mus- 
cles, in the ganglia of the sympathetic nerves, — all 
over the man, as one may say, as instinct seems dif- 
fused through every part of those lower animals that 
have no such distinct organ as a brain. See a skilful 
surgeon handle a broken limb ; see a wise old physi- 
cian smile away a case that looks to a novice as if the 
sexton would soon be sent for ; mark what a large 
experience has done for those who were fitted to profit 
by it, and you will feel convinced that, much as you 
know, something is still left for you to learn. 

May I venture to contrast youth and experience in 
medical practice, something in the way the man painted 
the lion, that is, the lion under ? 

The young man knows the rules, but the old man 
knows the exceptions. The young man knows his pa- 
tient, but the old man knows also his patient's family, 
dead and alive, up and down for generations. He can 
tell beforehand what diseases their unborn children 
will be subject to, what they will die of if they live 
long enough, and whether they had better live at all, 
or remain unrealized possibilities, as belonging to a 
stock not worth being perpetuated. The young man 
feels uneasy if he is not continually doing something 
to stir up his patient's internal arrangements. The 
old man takes things more quietly, and is much more 
willing to let well enough alone. All these superiori- 
ties, if such they are, you must wait for time to bring 
you. In the meanwhile (if we will let the lion be up- 
permost for a moment), the young man's senses are 
quicker than those of his older rival. His education 
in all the accessory branches is more recent, and there- 



378 MEDICAL ESSAYS. 

fore nearer the existing condition of knowledge. He 
finds it easier than his seniors to accept the improve- 
ments which every year is bringing forward. New ideas 
build their nests in young men's brains. " Revolutions 
are not made by men in spectacles," as I once heard 
it remarked, and the first whispers of a new truth are 
not caught by those who begin to feel the need of an 
ear-trumpet. Granting all these advantages to the 
young man, he ought, nevertheless, to go on improving, 
on the whole, as a medical practitioner, with every 
year, until he has ripened into a well-mellowed matu- 
rity. But, to improve, he must be good for something 
at the start. If you ship a poor cask of wine to India 
and back, if you keep it a half a century, it only grows 
thinner and sharper. 

You are soon to enter into relations with the pub- 
lic, to expend your skill and knowledge for its benefit, 
and find your support in the rewards of your labor. 
What kind of a constituency is this which is to look to 
you as its authorized champions in the struggle of life 
against its numerous enemies ? 

In the first place, the persons who seek the aid of 
the physician are very honest and sincere in their wish 
to get rid of their complaints, and, generally speaking, 
to live as long as they can. However attractively the 
future is painted to them, they are attached to the 
planet with which they are already acquainted. They 
are addicted to the daily use of this empirical and un- 
ohemical mixture which we call air, and would hold on 
to it as a tippler does to his alcoholic drinks. There 
is nothing men will not do, there is nothing they have 
not done, to recover their health and save their lives. 
They have submitted to be half-drowned in water, and 
half -choked with gases, to be buried up to their chins 



THE YOUNG PRACTITIONER. 379 

in earth, to be seared with hot irons like galley-slaves, 
to be crimped with knives, like cod-fish, to have needles 
thrust into their flesh, and bonfires kindled on their 
skin, to swallow all sorts of abominations, and to pay 
for all this, as if to be singed and scalded were a costly 
privilege, as if blisters were a blessing, and leeches 
were a luxury. What more can be asked to prove their 
honesty and sincerity ? 

This same community is very intelligent with respect 
to a great many subjects — commerce, mechanics, man- 
ufactures, politics. But with regard to medicine it is 
hopelessly ignorant and never finds it out. I do not 
know that it is any worse in this country than in Great 
Britain, where Mr. Huxley speaks very freely of " the 
utter ignorance of the simplest laws of their own ani- 
mal life, which prevails among even the most highly- 
educated persons." And Cullen said before him : 
" Neither the acutest genius nor the soundest judgment 
will avail in judging of a particular science, in regard 
to which they have not been exercised. I have been 
obliged to j)lease my patients sometimes with reasons, 
and I have found that any will pass, even with able 
divines and acute lawyers ; the same will pass with the 
husbands as with the wives." If the community could 
only be made aware of its own utter ignorance, and in- 
competence to form opinions on medical subjects, diffi- 
cult enough to those who give their lives to the study 
of them, the practitioner would have an easier task. 
But it will form opinions of its own, it cannot help it, 
and we cannot blame it, even though we know how 
slight and deceptive are their foundations. 

This is the way it happens *. Every grown-up person 
has either been ill himself or had a friend suffer from 
illness, from which he has recovered. Every sick per- 



380 MEDICAL ESSAYS. 

son has done something or other by somebody's advice, 
or of his own accord, a little before getting better. 
There is an irresistible tendency to associate the thing 
done, and the improvement which followed it, as cause 
and effect. This is the great source of fallacy in med- 
ical practice. But the physician has some chance of 
correcting his hasty inference. He thinks his prescrip- 
tion cured a single case of a particular complaint ; he 
tries it in twenty similar cases without effect, and sets 
down the first as probably nothing more than a coin- 
cidence. The unprofessional experimenter or observer 
has no large experience to correct his hasty general- 
ization. He wants to believe that the means he em- 
ployed effected his cure. He feels grateful to the 
person who advised it, he loves to praise the pill or 
potion which helped him, and he has a kind of monu- 
mental pride in liimself as a living testimony to its 
efficacy. So it is that you will find the community in 
which you live, be it in town or country, full of brands 
plucked from the burning, as they believe, by some 
agency which, with your better training, 3*011 feel rea- 
sonably confident had nothing to do with it. Their 
disease went out of itself, and the stream from the 
medical fire-annihilator had never even touched it. 

You cannot and need not expect to disturb the pub- 
lic in the possession of its medical superstitions. A 
man's ignorance is as much his private property, and 
as precious in his own eyes, as his family Bible. You 
have only to open your own Bible at the ninth chapter 
of St. Jolm\s Gospel, and you will find that the logic 
of a restored patient was very simple then, as it is now, 
and very hard to deal with. My clerical friends will 
forgive me for poaching on their sacred territory, in 
return for an occasional raid upon the medical domain 
of which they have now and then been accused. 



THE YOUNG PRACTITIONER. 381 

A blind man was said to have been restored to sight 
by a young person whom the learned doctors of the 
Jewish law considered a sinner, and, as such, very un- 
likely to have been endowed with a divine gift of heal- 
ing. They visited the patient repeatedly, and evidently 
teased him with their questions about the treatment, 
and their insinuations about the young man, until he 
lost his tenrper. At last he turned sharply upon them : 
" Whether he be a sinner or no, I know not : one thing 
I know, that, whereas I was blind, now I see." 

This is the answer that always has been and always 
will be given by most persons when they find them- 
selves getting well after doing anything, no matter 
what, — recommended by anybody, no matter whom. 
Lord Bacon, Robert Boyle, Bishop Berkeley, all put 
their faith in panaceas which we should laugh to scorn. 
They had seen people get well after using them. Are 
we any wiser than those great men ? Two years ago, in 
a lecture before the Massachusetts Historical Society, I 
mentioned this recipe of Sir Kenelm Digby for fever 
and ague : Pare the patient's nails ; put the parings in 
a little bag, and hang the bag round the neck of a live 
eel, and place him in a tub of water. The eel will die, 
and the patient will recover. 

Referring to this prescription in the course of the 
same lecture, I said : " You smiled when I related Sir 
Kenelm Digby' s prescription, with the live eel in it ; 
but if each of you were to empty his or her pockets, 
would there not roll out, from more than one of them, 
a horse-chestnut, carried about as a cure for rheuma- 
tism ? " Nobody saw fit to empty his or her pockets, 
and my question brought no response. But two months 
ago I was in a company of educated persons, college 
graduates every one of them, when a gentleman, well 



382 MEDICAL ESSAYS. 

known in our community, a man of superior ability and 
strong common-sense, on the occasion of some talk 
arising about rheumatism, took a couple of very shiny 
horse-chestnuts from his breeches-pocket, and laid them 
on the table, telling us how, having suffered from the 
complaint in question, he had, by the advice of a friend 9 
procured these two horse-chestnuts on a certain time 
a year or more ago, and carried them about him ever 
since ; from which very day he had been entirely free 
from rheumatism. 

This argument, from what looks like cause and effect, 
whether it be so or not, is what you will have to meet 
wherever you go, and you need not think you can an- 
swer it. In the natural course of things some thou- 
sands of persons must be getting well or better of 
slight attacks of colds, of rheumatic pains, every week, 
in this city alone. Hundreds of them do something 
or other in the way of remedy, by medical or other ad- 
vice, or of their own motion, and the last thing they 
do gets the credit of the recovery. Think what a crop 
of remedies this must furnish, if it were all harvested ! 

Experience has taught, or will teach you, that most 
of the wonderful stories patients and others tell of sud- 
den and signal cures are like Owen Glendower's story 
of the portents that announced his birth. The earth 
shook at your nativity, did it ? Very likely, and 

" So it would have done, 
At the same season, if your mother's cat 

Had kittened, though yourself had ne'er been born." 

You must listen more meekly than Hotspur did to the 
babbling Welshman, for ignorance is a solemn and 
sacred fact, and, like infancy, which it resembles, 
should be respected. Once in a while you will have a 
patient of sense, born with the gift of observation, 



THE YOUNG PRACTITIONER. 383 

from whom you may learn something. When you find 
yourself in the presence of one who is fertile of medi- 
cal opinions, and affluent in stories of marvellous 
cures, — of a member of Congress whose name figures 
in certificates to the value of patent medicines, of a 
voluble dame who discourses on the miracles she has 
wrought or seen wrought with the little jokers of the 
sugar-of-milk globule-box, take out your watch and 
count the pulse ; also note the time of day, and charge 
the price of a visit for every extra fifteen, or, if you 
are not very busy, every twenty minutes. In this way 
you will turn what seems a serious dispensation into' a 
double blessing, for this class of patients loves dearly 
to talk, and it does them a deal of good, and you feel 
as if you had earned your money by the dose you have 
taken, quite as honestly as by any dose you may have 
ordered. 

You must take the community just as it is, and make 
the best of it. You wish to obtain its confidence ; there 
is a short rule for doing this which you will find use- 
ful, — deserve it. But, to deserve it in full measure, 
you must unite many excellences, natural and acquired. 

As the basis of all the rest, you must have all those 
traits of character which fit you to enter into the most 
intimate and confidential relations with the families of 
which you are the privileged friend and counsellor. 
Medical Christianity, if I may use such a term, is of 
very early date. By the oath of Hippocrates, the 
practitioner of ancient times bound himself to enter 
his patient's house with the sole purpose of doing him 
good, and so to conduct himself as to avoid the very 
appearance of evil. Let the physician of to-day begin 
by coming up to this standard, and add to it all the 
more recently discovered virtues and graces. 



384 MEDICAL ESSAYS. 

A certain amount of natural ability is requisite to 
make you a good physician, but by no means that dis- 
proportionate development of some special faculty 
which goes by the name of genius. A just balance of 
the mental powers is a great deal more likely to be 
useful than any single talent, even were it the power 
of observation, in excess. For a mere observer is lia- 
ble to be too fond of facts for their own sake, so that, 
if he told the real truth, he would confess that he 
takes more pleasure in a post-mortem examination 
which shows him what was the matter with a patient, 
than in a case which insists on getting well and leav- 
ing him in the dark as to its nature. Far more likely 
to interfere with the sound practical balance of the 
mind is that specidative, theoretical tendency which 
has made so many men noted in their day, whose fame 
lias passed away with their dissolving theories. Read 
Dr. Bartlett's comparison of the famous Benjamin 
Rush with his modest fellow-townsman Dr. William 
Carrie, and see the dangers into which a passion for 
grandiose generalizations betrayed a man of many ad- 
mirable qualities. 

I warn you against all ambitious aspirations outside 
of your profession. Medicine is the inost difficult of 
sciences and the most laborious of arts. It will task 
all your powers of body and mind if you are faithful 
to it. Do not dabble in the muddy sewer of politics, 
nor linger by the enchanted streams of literature, nor 
dig in far-off fields for the hidden waters of alien sci- 
ences. The great practitioners are generally those 
who concentrate all their powers on their business. If 
there are here and there brilliant exceptions, it is only 
in virtue of extraordinary gifts, and industry to which 
very few are equal. 



THE YOUNG PRACTITIONER. 385 

To get business a man must really want it ; and do 
you suppose that when you are in the middle of a 
heated caucus, or half-way through a delicate analysis, 
or in the spasm of an unfinished ode, your eyes rolling 
in the fine frenzy of poetical composition, you want to 
be called to a teething infant, or an ancient person 
groaning under the griefs of a lumbago ? I think I 
have known more than one young man whose doctor's 
sign proclaimed his readiness to serve mankind in that 
capacity, but who hated the sound of a patient's 
knock, and as he sat with his book or his microscope, 
felt exactly as the old party expressed himself in my 
friend Mr. Brownell's poem — 

" All I axes is, let me alone." 

The community soon finds out whether you are in 
earnest, and really mean business, or whether you are 
one of those diplomaed dilettanti who like the amuse- 
ment of jpiasi medical studies, but have no idea of 
wasting their precious time in putting their knowledge 
in practice for the benefit of their suffering fellow- 
creatures. 

The public is a very incompetent judge of your skill 
and knowledge, but it gives its confidence most readily 
to those who stand well with their professional breth- 
ren, whom they call upon when they themselves or 
their families are sick, whom they choose to honorable 
offices, whose writings and teachings they hold in es- 
teem. A man may be much valued by the profession 
and yet have defects which prevent his becoming a 
favorite practitioner, but no popularity can be de- 
pended upon, as permanent which is not sanctioned by 
the judgment of professional experts, and with these 
you will always stand on your substantial merits. 

25 



386 MEDICAL ESSAYS. 

What shall I say of the personal habits you must 
form if you wish for success ? Temperance is first 
upon the list. Intemperance in a physician partakes 
of the guilt of homicide, for the muddled brain may 
easily make a fatal blunder in a prescription and the 
unsteady hand transfix an artery in an operation. Tip- 
pling doctors have been too common in the history of 
medicine. Paracelsus was a sot, Radcliffe was much 
too fond of his glass, and Dr. James Hurlbut of 
Wethersfield, Connecticut, a famous man in his time, 
used to drink a square bottle of rum a day, with a corre- 
sponding allowance of opium to help steady his nerves. 
We commonly speak of a man as being the worse for 
liquor, but I was asking an Irish laborer one day 
about his doctor, who, as he said, was somewhat given 
to drink. " I like him best when he 's a little that 
way," he said ; " then I can spake to him." I pitied 
the poor patient who could not venture to allude to his 
colic or his pleurisy until his physician was tipsy. 

There are personal habits of less gravity than the 
one I have mentioned which it is well to guard against, 
or, if they are formed, to relinquish. A man who may 
be called at a moment's warning into the fragrant bou- 
doir of suffering loveliness should not unsweeten its 
atmosphere with reminiscences of extinguished meer- 
schaums. He should remember that the sick are sen- 
sitive and fastidious, that they love the sweet odors 
and the pure tints of flowers, and if his presence is not 
like the breath of the rose, if his hands are not like 
the leaf of the lily, his visit may be unwelcome, and if 
he looks behind him he may see a window thrown open 
after he has left the sick-chamber. I remember too 
well the old doctor who sometimes came to help me 
through those inward grief s to which childhood is lia- 



THE YOUNG PRACTITIONER. 387 

ble. " Far off his coming " — shall I say " shone," 
and finish the Miltonic phrase, or leave the verb to the 
happy conjectures of my audience ? Before him came 
a soul-subduing whiff of ipecacuanha, and after him 
lingered a shuddering consciousness of rhubarb. He 
had lived so much among his medicaments that he had 
at last become himself a drug, and to have him pass 
through a sick-chamber was a stronger dose than a 
conscientious disciple of Hahnemann would think it 
safe to administer. 

Need I remind you of the importance of punctuality 
in your engagements, and of the worry and distress to 
patients and their friends which the want of it occa- 
sions? One of my old teachers always carried two 
watches, to make quite sure of being exact, and not 
only kept his appointments with the regularity of a 
chronometer, but took great pains to be at his patient's 
house at the time when he had reason to believe he 
was expected, even if no express appointment was 
made. It is a good rule ; if you call too early, my 
lady's hair may not be so smooth as could be wished, 
and, if you keep her waiting too long, her hair may be 
smooth, but her temper otherwise. 

You will remember, of course, always to get the 
weather-gage of your patient. I mean, to place him 
so that the light falls on his face and not on yours. It 
is a kind of ocular duel that is about to take place be- 
tween you ; you are going to look through his features 
into his pulmonary and hepatic and other internal ma- 
chinery, and he is going to look into yours quite as 
sharply to see what you think about his probabilities 
for time or eternity. 

No matter how hard he stares at your countenance, 
he should never be able to read his fate in it. It 



388 MEDICAL ESSAYS. 

should be cheerful as long as there is hope, and serene 
in its gravity when nothing is left but resignation. 
The face of a physician, like that of a diplomatist, 
should be impenetrable. Nature is a benevolent old 
hypocrite ; she cheats the sick and the dying with illu- 
sions better than any anodynes. If there are cogent 
reasons why a patient should be undeceived, do it de- 
liberately and advisedly, but do not betray your appre- 
hensions through your tell-tale features. 

We had a physician in our city whose smile was 
commonly reckoned as being worth five thousand dol- 
lars a year to him, in the days, too, of moderate in- 
comes. You cannot put on such a smile as that any 
more than you can get sunshine without sun ; there 
was a tranquil and kindly nature under it that irradi- 
ated the pleasant face it made one happier to meet on 
his daily rounds. But you can cultivate the disposi- 
tion, and it will work its way through to the surface, — 
nay, more, — you can try to wear a quiet and encour- 
aging look, and it will react on your disposition and 
make you like what you seem to be, or at least bring 
you nearer to its own likeness. 

Your patient has no more right to all the truth you 
know than he has to all the medicine in your saddle- 
bags, if you carry that kind of cartridge-box for the 
ammunition that slays disease. He should get only 
just so much as is good for him. I have seen a physi- 
cian examining a patient's chest stop all at once, as he 
brought out a particular sound with a tap on the col- 
lar-bone, in the attitude of a pointer who has just come 
on the scent or sight of a woodcock. You remember 
the Spartan boy, who, with unmoved countenance, hid 
the fox that was tearing his vitals beneath his mantle. 
What he could do in his own suffering you must learn 



THE YOUNG PRACTITIONER. 389 

to do for others on whose vital organs disease has fast- 
ened its devouring teeth. It is a terrible thing to take 
away hope, even earthly hope, from a fellow-creature. 
Be very careful what names you let fall before your 
patient. He knows what it means when you tell him 
he has tubercles or Bright's disease, and, if he hears 
the word carcinoma, he will certainly look it out in a 
medical dictionary, if he does not interpret its dread 
significance on the instant. Tell him he has asthmatic 
symptoms, or a tendency to the gouty diathesis, and 
he will at once think of all the asthmatic and gouty 
old patriarchs he has ever heard of, and be comforted. 
You need not be so cautious in speaking of the health 
of rich and remote relatives, if he is in the line of suc- 
cession. 

Some shrewd old doctors have a few phrases always 
on hand for patients that will insist on knowing the 
pathology of their complaints without the slightest ca- 
pacity of understanding the scientific explanation. I 
have known the term " spinal irritation " serve well 
on such occasions, but I think nothing on the whole 
has covered so much ground, and meant so little, and 
given such profound satisfaction to all parties, as the 
magnificent phrase " congestion of the portal system." 

Once more, let me recommend you, as far as possi- 
ble, to keep your doubts to yourself, and give the pa- 
tient the benefit of your decision. Firmness, gentle 
firmness, is absolutely necessary in this and certain 
other relations. Mr. Rarey with Cruiser, Richard with 
Lady Ann, Pinel with his crazy people, show what 
steady nerves can do with the most intractable of ani- 
mals, the most irresistible of despots, and the most un- 
manageable of invalids. 

If you cannot acquire and keep the confidence of 



390 MEDICAL ESSAYS. 

your patient, it is time for you to give place to some 
other practitioner who can. If you are wise and dili- 
gent, you can establish relations with the best of them 
which they will find it very hard to break. But, if 
they wish to employ another person, who, as they 
think, knows more than you do, do not take it as a 
personal wrong. A patient believes another man can 
save his life, can restore him to health, which, as he 
thinks, you have not the skill to do. No matter 
whether the patient is right or wrong, it is a great im- 
pertinence to think you have any property in him. 
Your estimate of your own ability is not the question, 
it is what the patient thinks of it. All your wisdom 
is to him like the lady's virtue in Raleigh's song : — 

" If she seem not ehaste to me, 
What care I how chaste she be? " 

What I call a good patient is one who, having found 
a good physician, sticks to him till he dies. But there 
are many very good people who are not what I call 
good patients. I was once requested to call on a lady 
suffering from nervous and other symptoms. • It came 
out in the preliminary conversational skirmish, half 
medical, half social, that I was the tiventy-sixth mem- 
ber of the faculty into whose arms, professionally 
speaking, she had successively thrown herself. Not 
being a believer in such a rapid rotation of scientific 
crops, I gently deposited the burden, commending it 
to the care of number twenty-seven, and, him, whoever 
he might be, to the care of Heaven. 

If there happened to be among my audience any 
person who wished to know on what principles the pa- 
tient should choose his physician, I should give him 
these few precepts to think over : — 



THE YOUNG PRACTITIONER. 391 

Choose a man who is personally agreeable, for a 
daily visit from an intelligent, amiable, pleasant, sym- 
pathetic person will cost you no more than one from a 
sloven or a boor, and his presence will do more for 
you than any prescription the other will order. 

Let him be a man of recognized good sense in other 
matters, and the chance is that he will be sensible as 
a practitioner. 

Let him be a man who stands well with his profes- 
sional brethren, whom they approve as honest, able, 
courteous. 

Let him be one whose patients are willing to die in 
his hands, not one whom they go to for trifles, and 
leave as soon as they are in danger, and who can say, 
therefore, that he never loses a patient. 

Do not leave the ranks of what is called the regu- 
lar profession, unless you wish to go farther and fare 
worse, for you may be assured that its members recog- 
nize no principle which hinders their accepting any 
remedial agent proved to be useful, no matter from 
what quarter it comes. The difficulty is that the 
stragglers, organized under fantastic names in preten- 
tious associations, or lurking in solitary dens behind 
doors left ajar, make no real contributions to the art 
of healing. When they bring forward a remedial 
agent like chloral, like the bromide of potassium, like 
ether, used as an anaesthetic, they will find no diffi- 
culty in procuring its recognition. 

Some of you will probably be more or less troubled 
by the pretensions of that parody of mediaeval theol- 
ogy which finds its dogma of hereditary depravity in 
the doctrine of psora, its miracle of transubstantiation 
in the mystery of its triturations and dilutions, its 
church in the people who have mistaken their century, 



392 MEDICAL ESSAYS. 

and its priests in those who have mistaken their call- 
ing. You can do little with persons who are disposed 
to accept these curious medical superstitions. The 
saturation-point of individual minds with reference to 
evidence, and especially medical evidence, differs, and 
must always continue to differ, very widely. There 
are those whose minds are satisfied with the decillionth 
dilution of a scientific proof. No wonder they believe 
in the efficacy of a similar attenuation of bryony or 
Pulsatilla. You have no fulcrum you can rest upon 
to lift an error out of such minds as these, often 
highly endowed with knowledge and talent, sometimes 
with genius, but commonly richer in the imaginative 
than the observing and reasoning faculties. 

Let me return once more to the young graduate. 
Your relations to your professional brethren may be a 
source of lifelong happiness and growth in knowledge 
and character, or they may make you wretched and 
end by leaving you isolated from those who should be 
your friends and counsellors. The life of a physician 
becomes ignoble when he suffers himself to feed on 
petty jealousies and sours his temper in perpetual 
quarrels. You will be liable to meet an uncomforta- 
ble man here and there in the profession, — one who is 
so fond of being in hot water that it is a wonder all 
the albumen in his body is not coagulated. There are 
common barrators among doctors as there are among 
lawyers, — stirrers up of strife under one pretext and 
another, but in reality because they like it. They are 
their own worst enemies, and do themselves a mischief 
each time they assail their neighbors. In my student- 
da}^ I remember a good deal of this Donnybrook-Fair 
style of quarrelling, more especially in Paris, where 
some of the noted surgeons were always at logger. 



THE YOUNG PRACTITIONER. 393 

heads, and in one of our lively Western cities. Soon 
after I had set up an office, I had a trifling experience 
which may. serve to point a moral in this direction. I 
had placed a lamp behind the glass in the entry to in- 
dicate to the passer-by where relief from all curable 
infirmities was to be sought and found. Its brilliancy 
attracted the attention of a devious youth, who dashed 
his fist through the glass and upset my modest lumi- 
nary. All he got by his vivacious assault was that he 
left portions of integument from his knuckles upon 
the glass, had a lame hand, was very easily identified, 
and had to pay the glazier's bill. The moral is that, 
if the brilliancy of another's reputation excites your 
belligerent instincts, it is not worth your while to 
strike at it, without calculating which of you is likely 
to suffer most, if you do. 

You may be assured that when an ill-conditioned 
neighbor is always complaining of a bad taste in his 
mouth and an evil atmosphere about him, there is 
something wrong about his own secretions. In such 
cases there is an alterative regimen of remarkable effi- 
cacy : it is a starvation- diet of letting alone. The great 
majority of the profession are peacefully inclined. 
Their pursuits are eminently humanizing, and they 
look with disgust on the personalities which intrude 
themselves into the placid domain of an art whose 
province it is to heal and not to wound. 

The intercourse of teacher and student in a large 
school is necessarily limited, but it should be, and, so 
far as my experience goes, it is, eminently cordial and 
kindly. You will leave with regret, and hold in tender 
remembrance, those who have taken you by the hand 
at your entrance on your chosen path, and led you 
patiently and faithfully, until the great gates at its end 



394 MEDICAL ESSAYS. 

have swung upon their hinges, and the world lies open 
before you. That venerable oath to which I have be- 
fore referred bound the student to regard his instructor 
in the light of a parent, to treat his children like broth- 
ers, to succor him in his day of need. I trust the 
spirit of the oath of Hippocrates is not dead in the 
hearts of the students of to-day. They will remember 
with gratitude every earnest effort, every encouraging 
word, which has helped them in their difficult and la- 
borious career of study. The names they read on 
their diplomas will recall faces that are like family- 
portraits in their memory, and the echo of voices they 
have listened to so long will linger in their memories 
far into the still evening of their lives. 

One voice will be heard no more which has been 
familiar to many among you. It is not for me, a 
stranger to these scenes, to speak his eulogy. I have 
no right to sadden this hour by dwelling on the deep 
regrets of friendship, or to bid the bitter tears of sor- 
row flow afresh. Yet I cannot help remembering what 
a void the death of such a practitioner as your late in- 
structor must leave in the wide circle of those who 
leaned upon his counsel and assistance in their hour of 
need, in a community where he was so widely known 
and esteemed, in a school where he bore so important 
a part. There is no exemption from the common doom 
for him who holds the shield to protect others. The 
student is called from his bench, the professor from 
Ms chair, the practitioner in his busiest period hears a 
knock more peremptory than any patient's midnight 
summons, and goes on that unrcturning visit which ad- 
mits of no excuse, and suffers no delay. The call of 
such a man away from us is the bereavement of a great 
family. Nor can we help regretting the loss for him 



THE YOUNG PRACTITIONER. 395 

of a bright and cheerful earthly future ; for the old 
age of a physician is one of the happiest periods of his 
life. He is loved and cherished for what he has been, 
and even in the decline of his faculties there are oc- 
casions when his experience is still appealed to, and his 
trembling hands are looked to with renewing hope and 
trust, as being yet able to stay the arm of the destroyer. 

But if there is so much left for age, how beautiful, 
how inspiring is the hope of youth ! I see among those 
whom I count as listeners one by whose side I have 
sat as a fellow-teacher, and by whose instructions I 
have felt myself not too old to profit. As we borrowed 
him from your city, I must take this opportunity of 
telling you that his zeal, intelligence, and admirable 
faculty as an instructor were heartily and universally 
recognized among us. We return him, as we trust, un- 
injured, to the fellow-citizens who have the privilege of 
claiming him as their own. 

And now, gentlemen of the graduating class, nothing 
remains but for me to bid you, in the name of those for 
whom I am commissioned and privileged to speak, fare- 
well as students, and welcome as practitioners. I pro- 
nounce the two benedictions in the same breath, as the 
late king's demise and the new king's accession are pro- 
claimed by the same voice at the same moment. You 
would hardly excuse me if I stooped to any meaner 
dialect than the classical and familiar language of your 
prescriptions, the same in which your title to the name 
of physician is, if, like our own institution, you follow 
the ancient usage, engraved upon your diplomas. 

Valete, juvenes, artis medicce studio si ; valete, 
discipuli, valete, Jilii! 

Salvete, viri, artis medicce magistri ; salvete, am- 
id ; salvete, fratres/ 



VIII. 

MEDICAL LIBRARIES." 

It is my appointed task, my honorable privilege, 
this evening, to speak of what has been done by others. 
No one can bring his tribute of words into the pres- 
ence of great deeds, or try with them to embellish the 
memory of any inspiring achievement, without feeling 
and leaving with others a sense of their insufficiency. 
So felt Alexander when he compared even his adored 
Homer with the hero the poet had sung. So felt 
Webster when he contrasted the phrases of rhetoric 
with the eloquence of patriotism and of self-devotion. 
So felt Lincoln when on the field of Gettysburg he 
spoke those immortal words which Pericles could not 
have bettered, which Aristotle coidd not have criticised. 
So felt he who wrote the epitaph of the builder of the 
dome which looks down on the crosses and weather- 
cocks that glitter over London. 

We are not met upon a battle-field, except so far as 
every laborious achievement means a victory over op- 
position, indifference, selfishness, faintheartedness, and 
that great property of mind as well as matter, — inertia. 
We are not met in a cathedral, except so far as every 
building whose walls are lined with the products of use- 
ful and ennobling thought is a temple of the Almighty, 
whose inspiration has given us understanding. But 

" Dedicatory Address at the opening of the Medical Library 
in Boston, December 3, 1878. 



MEDICAL LIBRARIES. 397 

we have gathered within walls which bear testimony 
to the self-sacrificing, persevering efforts of a few 
young men, to whom we owe the origin and develop- 
ment of all that excites our admiration in this com- 
pleted enterprise ; and I might consider my task as 
finished if I contented myself with borrowing the last 
word of the architect's epitaph and only saying, Look 
around you ! 

The reports of the librarian have told or will tell 
you, in some detail, what has been accomplished since 
the 21st of December, 1874, when six gentlemen met 
at the house of Dr. Henry Ingersoll Bowditch to dis- 
cuss different projects for a medical library. In less 
than four years from that time, by the liberality of as- 
sociations and of individuals, this collection of nearly 
ten thousand volumes, of five thousand pamphlets, and 
of one hundred and twenty-five journals, regularly re- 
ceived, — all worthily sheltered beneath this lofty roof, 
— has come into being under our eyes. It has sprung 
up, as it were, in the night like a mushroom; it stands 
before us in full daylight as lusty as an oak, and prom- 
ising to grow and flourish in the perennial freshness of 
an evergreen. 

To whom does our profession owe this already large 
collection of books, exceeded in numbers only by four 
or five of the most extensive medical libraries in the 
country, and lodged in a building so well adapted to 
its present needs? We will not point out individually 
all those younger members of the profession who have 
accomplished what their fathers and elder brethren had 
attempted and partially achieved. We need not write 
their names on these walls, after the fashion of those 
civic dignitaries who immortalize themselves on tablets 
of marble and gates cf iron. But their contempora- 



398 MEDICAL ESSAYS. 

ries know tliem well, and their descendants will not 
forget them, — the men who first met together, the men 
who have given their time and their money, the faith- 
ful workers, worthy associates of the strenuous agitator 
who gave no sleep to his eyes, no slumber to his eye- 
lids, until he had gained his ends ; the untiring, im- 
perturbable, tenacious, irrepressible, all-subduing agi- 
tator who neither rested nor let others rest until the 
success of the project was assured. If, against his 
injunctions, I name Dr. James Read Chadwick, it is 
only my revenge for his having kept me awake so often 
and so long while he was urging on the undertaking 
in which he has been preeminently active and trium- 
phantly successful. 

We must not forget the various medical libraries 
which preceded this : that of an earlier period, when 
Boston contained about seventy regular practitioners, 
the collection afterwards transferred to the Boston 
Athenaeum ; the two collections belonging to the Uni- 
versity ; the Treadwell Library at the Massachusetts 
General Hospital ; the collections of the two societies, 
that for Medical Improvement and that for Medical 
Observation ; and more especially the ten thousand 
volumes relating to medicine belonging to our noble 
public city library, — too many blossoms on the tree of 
knowledge, perhaps, for the best fruit to ripen. But 
the Massachusetts Medical Society now numbers nearly 
four hundred members in the city of Boston. The 
time had arrived for a new and larger movement. 
There was needed a place to which every respectable 
member of the medical profession could obtain easy 
access ; where, under one roof, all might find the spe- 
cial information they were seeking ; where the latest 
medical intelligence should be spread out daily as the 



MEDICAL LIBRARIES. 399 

shipping news is posted on the bulletins of the ex- 
change ; where men engaged in a common pursuit 
could meet, surrounded by the mute oracles of science 
and art ; where the whole atmosphere should be as full 
of professional knowledge as the apothecary's shop is 
of the odor of his medicaments. This was what the 
old men longed for, — the prophets and kings of the 

profession, who 

"Desired it long, 
But died without the sight." 

This is what the young men and those who worked 
under their guidance undertook to give us. And now 
such a library, such a reading-room, such an exchange, 
such an intellectual and social meeting-place, we be- 
hold a fact, plain before us. The medical profession 
of our city, and, let us add, of all those neighboring 
places which it can reach with its iron arms, is united 
as never before by the commune vinculum, the com- 
mon bond of a large, enduring, ennobling, unselfish 
interest. It breathes a new air of awakened intel- 
ligence. It marches abreast of the other learned 
professions, which have long had their extensive and 
valuable centralized libraries ; abreast of them, but not 
promising to be content with that position. What 
glorifies a town like a cathedral ? What dignifies a 
province like a university? What illuminates a coun- 
try like its scholarship, and what is the nest that 
hatches scholars but a library ? 

The physician, some may say, is a practical man 
and has little use for all this book-learning. Every 
student has heard Sydenham's reply to Sir Richard 
131ackmore's question as to what books he should read, 
■ — meaning medical books. " Bead Don Quixote," 
was his famous answer. But Sydenham himself made 



400 MEDICAL ESSAYS. 

medical books and may be presumed to have thought 
those at least worth reading. Descartes was asked 
where was his library, and in reply held up the dis- 
sected body of an animal. But Descartes made books, 
great books, and a great many of them. A physician 
of common sense without erudition is better than a 
learned one without common sense, but the thorough 
master of his profession must have learning added to 
his natural gifts. 

It is not necessary to maintain the direct practical 
utility of all kinds of learning. Our shelves contain 
many books which only a certain class of medical 
scholars will be likely to consult. There is a dead 
medical literature, and there is a live one. The dead 
is not all ancient, the live is not all modern. There is 
none, modern or ancient, which, if it has no living 
value for the student, will not teach him something by 
its autopsy. But it is with the live literature of his 
profession that the medical practitioner is first of all 
concerned. 

Now there has come a great change in our time over 
the form in which living thought presents itself. The 
first printed books, — the incunabula, — were inclosed 
in boards of solid oak, with brazen clasps and corners ; 
the boards by and by were replaced by pasteboard cov- 
ered with calf or sheepskin ; then cloth came in and 
took the place of leather ; then the pasteboard was 
covered with paper instead of cloth ; and at this day 
the quarterly, the monthly, the weekly periodical in 
its flimsy unsupported dress of paper, and the daily 
journal, naked as it came from the womb of the press, 
hold the larger part of the fresh reading we live upon. 
We must have the latest thought in its latest expres- 
sion ; the page must be newly turned like the morning 



MEDICAL LIBRARIES. 401 

bannock ; the pamphlet must be newly opened like the 
ante-prandial oyster. 

Thus a library, to meet the need of our time, must 
take, and must spread out in a convenient form, a great 
array of periodicals. Our active practitioners read 
these by preference over almost everything else. Our 
specialists, more particularly, depend on the month's 
product, on the yearly crop of new facts, new sugges- 
tions, new contrivances, as much as the farmer on the 
annual yield of his acres. One of the first wants, then, 
of the profession is supplied by our library in its great 
array of periodicals from many lands, in many lan- 
guages. Such a number of medical periodicals no 
private library would have room for, no private person 
would pay for, or flood his tables with if they were 
sent him for nothing. These, I think, with the reports 
of medical societies and the papers contributed to them, 
will form the most attractive part of our accumulated 
medical treasures. They will be also one of our chief 
expenses, for these journals must be bound in volumes 
and they require a great amount of shelf-room ; all 
this, in addition to the cost of subscription for those 
which are not furnished us gratuitously. 

It is true that the value of old scientific periodicals 
is, other things being equal, in the inverse ratio of 
their age, for the obvious reason that what is most 
valuable in the earlier volumes of a series is drained 
oif into the standard works with which the intelligent 
practitioner is supposed to be familiar. But no ex- 
tended record of facts grows too old to be useful, pro- 
vided only that we have a ready and sure way of get- 
ting at the particular fact or facts we are in search of. 

And this leads me to speak of what I conceive to be 
one of the principal tasks to be performed by the pres- 

26 



402 MEDICAL ESSAYS. 

ent and the coming generation of scholars, not only 
in the medical, but in every department of knowledge. 
I mean the formation of indexes, and more especially 
of indexes to periodical literature. 

This idea has long been working in the minds of 
scholars, and all who have had occasion to follow out 
any special subject. I have a right to speak of it, for 
I long ago attempted to supply the want of indexes in 
some small measure for my own need. I had a very 
complete set of the " American Journal of the Medical 
Sciences ; " an entire set of the " North American Re- 
view,'' and many volumes of the reprints of the three 
leading British quarterlies. Of what use were they to 
me without general indexes ? I looked them all 
through carefully and made classified lists of all the 
articles I thought I should most care to read. But they 
soon outgrew my lists. The " North American Review " 
kept filling up shelf after shelf, rich in articles which I 
often wanted to consult, but what a labor to find them, 
until the index of Mr. Gushing, published a few months 
since, made the contents of these hundred and twenty 
volumes as easily accessible as the words in a diction- 
ary! I had a copy of good Dr. Abraham Rees's C}^- 
clopaedia, a treasure-house to my boyhood which has 
not lost its value for me in later years. But where to 
look for what T wanted ? I wished to know, for in- 
stance, what Dr. Burney had to say about singing. 
Who would have looked for it under the Italian word 
cantare f I was curious to learn something of the 
etchings of Rembrandt, and where should I find it but 
under the head " Low Countries, Engravers of the," 
— an elaborate and most valuable article of a hundred 
double-columned close-printed quarto pages, to which 
no reference, even, is made under the title Rembrandt 



MEDICAL LIBRARIES. 403 

There was nothing to be done, if I wanted to know 
where that which I specially cared for was to be found 
in my Rees's Cyclopaedia, but to look over every page 
of its forty-one quarto volumes and make out a brief 
list of matters of interest which I could not find by 
their titles, and this I did, at no small expense of time 
and trouble. 

Nothing, therefore, could be more pleasing to me 
than to see the attention which has been given of late 
years to the great work of indexing. It is a quarter 
of a century since Mr. Poole published his " Index to 
Periodical Literature," which it is much to be hoped is 
soon to appear in a new edition, grown as it must be to 
formidable dimensions by the additions of so long a 
period. The " British and Foreign Medical Review," 
edited by the late Sir John Forbes, contributed to by 
Huxley, Carpenter, Lay cock, and others of the most 
distinguished scientific men of Great Britain, has an 
index to its twenty-four volumes, and by its aid I find 
this valuable series as manageable as a lexicon. The last 
edition of the " Encyclopaedia Britannica " had a com- 
plete index in a separate volume, and the publishers of 
Appletons' " American Cyclopaedia " have recently is- 
sued an index to their useful work, which must greatly 
add to its value. I have already referred to the index to 
the " North American Review," which to an American, 
and especially to a New Englander, is the most inter- 
esting and most valuable addition of its kind to our liter- 
ary apparatus since the publication of Mr. Allibone's 
" Dictionary of Authors." I might almost dare to 
parody Mr. Webster's words in speaking of Hamilton, 
to describe what Mr. dishing did for the solemn rows 
of back volumes of our honored old Review which had 
been long fossilizing on our shelves : " He touched the 



404 MEDICAL ESSAYS, 

dead corpse of the " " North American," " and it sprang 
to its feet." A library of the best thought of the best 
American scholars during the greater portion of the 
century was brought to light by the work of the index- 
maker as truly as were the Assyrian tablets by the 
labors of La} r ard. 

A great portion of the best writing and reading — 
literary, scientific, professional, miscellaneous — comes 
to us now, at stated intervals, in paper covers. The 
writer appears, as it were, in his shirt-sleeves. As soon 
as he has delivered his message the book-binder puts a 
coat on his back, and he joins the forlorn brotherhood 
of "back volumes," than which, so long as they are 
un indexed, nothing can be more exasperating. Who 
wants a lock without a key, a ship without a rudder, a 
binnacle without a compass, a check without a signa- 
ture, a greenback without a goldback behind it ? 

I have referred chiefly to the medical journals, but I 
would include with these the reports of medical associa- 
tions, and those separate publications which, coming 
in the form of pamphlets, heap themselves into chaotic 
piles and bundles which are worse than useless, taking 
up a great deal of room, and frightening everything 
away but mice and mousing antiquarians, or possibly 
at long intervals some terebrating specialist. 

Arranged, bound, indexed, all these at once be- 
come accessible and valuable. I will take the first in- 
stance which happens to suggest itself. How many 
who know all about osteoblasts and the experiments of 
Oilier, and all that lias grown out of them, know where 
to go for a paper by the late Dr. A. L. Peirson of 
Salem, published in the year 1840, under the modest 
title, Remarks on Fractures ? And if any practitioner 
who has to deal with broken bones does not know that 



MEDICAL LIBRARIES. 405 

most excellent and practical essay, it is a great pity, 
for it answers very numerous questions which will be 
sure to suggest themselves to the surgeon and the pa- 
tient as no one of the recent treatises, on my own 
shelves, at least, can do. 

But if indexing is the special need of our time in 
medical literature, as in every department of knowl- 
edge, it must be remembered that it is not only an im- 
mense labor, but one that never ends. It requires, 
therefore, the cooperation of a large number of individ- 
uals to do the work, and a large amount of money to 
pay for making its results public through the press. 
When it is remembered that the catalogue of the 
library of the British Museum is contained in nearly 
three thousand large folios of manuscript, and not all 
its books are yet included, the task of indexing any 
considerable branch of science or literature looks as if 
it were well nigh impossible. But many hands make 
light work. An " Index Society " has been formed in 
England, already numbering about one hundred and 
seventy members. It aims at u supplying thorough 
indexes to valuable works and collections which have 
hitherto lacked them ; at issuing indexes to the liter- 
ature of special subjects ; and at gathering materials 
for a general reference index." This society has pub- 
lished a little treatise setting forth the history and the 
art of indexing, which I trust is in the hands of some 
of our members, if not upon our shelves. 

Something has been done in the same direction by 
individuals in our own country, as we have already 
seen. The need of it in the department of medicine 
is beginning to be clearly felt. Our library has al- 
ready an admirable catalogue with cross references, 
the work of a number of its younger members coop 



406 MEDICAL ESSAYS. 

erating in the task. A very intelligent medical stu- 
dent, Mr. William D. Chapin, whose excellent project 
is indorsed by well-known New York physicians and 
professors, proposes to publish a yearly index to orig- 
inal communications in the medical journals of the 
United States, classified by authors and subjects. But 
it is from the National Medical Library at Washing- 
ton that we have the best promise and the largest ex- 
pectations. That great and growing collection of fifty 
thousand volumes is under the eye and hand of a li- 
brarian who knows books and how to manage them. 
For libraries are the standing armies of civilization, 
and an army is but a mob without a general who can 
organize and marshal it so as to make it effective. 
The " Specimen Fasciculus of a Catalogue of the Na- 
tional Medical Library," prepared under the direction 
of Dr. Billings, the librarian, would have excited the 
admiration of Haller, the master scholar in medical 
science of the last century, or rather of the profession 
in all centuries, and if carried out as it is begun will 
be to the nineteenth all and more than all that the 
three Bibliothecre — Anatomica, Chirurgica, and Med- 
icinae-Practicae — were to the eighteenth century. I 
cannot forget the story that Agassi z was so fond of 
telling of the kino; of Prussia and Fichte. It was after 
the humiliation and spoliation of the kingdom by Na- 
poleon that the monarch asked the philosopher what 
could be done to regain the lost position of the nation. 
"Found a great university, Sire," was the answer, and 
so it was that in the year 1810 the world-renowned 
University of Berlin came into being. I believe that 
we in this country can do better than found a national 
university, whose professors shall be nominated in 
caucuses, go in and out, perhaps, like postmasters, 



MEDICAL LIBRARIES. 407 

with every change of administration, and deal with 
science in the face of their constituency as the courtier 
did with time when his sovereign asked him what 
o'clock it was : " Whatever hour your majesty pleases.'" 
But when we have a noble library like that at Wash- 
ing-ton, and a librarian of exceptional qualifications 
like the gentleman who now holds that office, I believe 
that a liberal appropriation by Congress to carry out 
a conscientious work for the advancement of sound 
knowledge and the bettering of human conditions, like 
this which Dr. Billings has so well begun, would re- 
dound greatly to the honor of the nation. It ought to 
be willing to be at some charge to make its treasures 
useful to its citizens, and, for its own sake, especially 
to that class which has charge of health, public and 
private. This country abounds in what are called 
" self-made men," and is justly proud of many whom 
it thus designates. In one sense no man is self-made 
who breathes the air of a civilized community. In an- 
other sense every man who is anything other than a 
phonograph on legs is self-made. But if we award his 
just praise to the man who has attained any kind of 
excellence without having had the same advantages as 
others whom, nevertheless, he has equalled, or sur- 
passed, let us not be betrayed into undervaluing the 
mechanic's careful training to his business, the thor- 
ough and laborious education of the scholar and the 
professional man. 

Our American atmosphere is vocal with the flippant 
loquacity of half knowledge. We must accept what- 
ever good can be got out of it, and keep it under as 
we do sorrel and mullein and witchgrass, by enriching 
the soil, and sowing good seed in plenty; by good 
teaching and good books, rather than by wasting our 



408 MEDICAL ESSAYS. 

time in talking against it. Half knowledge dreads 
nothing but whole knowledge. 

I have spoken of the importance and the predomi- 
nance of periodical literature, and have attempted to 
do justice to its value. But the almost exclusive read- 
ing of it is not without its dangers. The journals con- 
tain much that is crude and unsound ; the presump- 
tion, it might be maintained, is against their novelties, 
unless they come from observers of established credit. 
Yet I have known a practitioner, — perhaps more than 
one, — who was as much under the dominant influence 
of the last article he had read in his favorite medical 
journal as a milliner under the sway of the last fash- 
ion-plate. The difference between green and seasoned 
knowledge is very great, and such practitioners never 
hold long enough to any of their knowledge to have it 
get seasoned. 

It is needless to say, then, that all the substantial 
and permanent literature of the profession should be 
represented upon our shelves. Much of it is there al- 
ready, and as one private library after another falls 
into tliis by the natural law of gravitation, it will grad- 
ually acquire all that is most valuable almost without 
effort. A scholar should not be in a hurry to part 
with his books. They are probably more valuable to 
him than they can be to any other individual. What 
Swedenborg called u correspondence " has established 
itself between his intelligence and the volumes which 
wall him within their sacred inclosure. Napoleon said 
that his mind was as if furnished with drawers, — he 
drew out each as he wanted its contents, and closed it 
at will when done with them. The scholar's mind, to 
use a similar comparison, is furnished with shelves, 
like his library. Each book knows its place in the 



MEDICAL LIBRARIES. 409 

brain as well as against the wall or in the alcove. His 
consciousness is doubled by the books which encircle 
him, as the trees that surround a lake repeat them- 
selves in its unruffled waters. Men talk of the nerve 
that runs to the pocket, but one who loves his books, 
and has lived long with them, has a nervous filament 
which runs from his sensorium to every one of them. 
Or, if I may still let my fancy draw its pictures, a 
scholar's library is to him what a temple is to the wor- 
shipper who frequents it. There is the altar sacred to 
his holiest experiences. There is the font where his 
new-born thought was baptized and first had a name 
in his consciousness. There is the monumental tablet 
of a dead belief, sacred still in the memory of what it 
was while yet alive. No visitor can read all this on 
the lettered backs of the books that have gathered 
aroimd the scholar, but for him, from the Aldus on 
the lowest shelf to the Elzevir on the highest, every 
volume has a language which none but he can inter- 
pret. Be patient with the book-collector who loves his 
companions too well to let them go. Books are not 
buried with their owners, and the veriest book-miser 
that ever lived was probably doing far more for his 
successors than his more liberal neighbor who despised 
his learned or unlearned avarice. Let the fruit fall 
with the leaves still clinging round it. Who would 
have stripped Southey's walls of the books that filled 
them, when, his mind no longer capable of taking in 
their meaning, he would still pat and fondle them with 
the vague loving sense of what they had once been to 
him, — to him, the great scholar, now like a little child 
among his playthings ? 

We need in this country not only the scholar, but the 
virtuoso^ who hoards the treasures which he loves, it 



410 MEDICAL ESSAYS. 

may be chiefly for their rarity and because others who 
know more than he does of their value set a high price 
upon them. As the wine of old vintages is gently de- 
canted out of its cobwebbed bottles with their rotten 
corks into clean new receptacles, so the wealth of the 
New World is quietly emptying many of the libraries 
and galleries of the Old World into its newly formed 
collections and newly raised edifices. And this process 
must go on in an accelerating ratio. No Englishman 
will be offended if I say that before the New Zealander 
takes his stand on a broken arch of London Bridge to 
sketch the ruins of St. Paul's in the midst of a vast 
solitude, the treasures of the British Museum will have 
found a new shelter in the halls of New York or Bos- 
ton. No Catholic will think hardly of my saying that 
before the Coliseum falls, and with it the imperial city, 
whose doom prophecy has linked with that of the al- 
most eternal amphitheatre, the marbles, the bronzes, 
the paintings, the manuscripts of the Vatican will have 
left the shores of the Tiber for those of the Potomac, 
the Hudson, the Mississippi, or the Sacramento. And 
what a delight in the pursuit of the rarities which the 
eager book-hunter follows with the scent of a beagle ! 
Shall I ever forget that rainy day in Lyons, that dingy 
bookshop, where I found the Actius, long missing from 
my Artis Medicae Principes, and where I bought for 
a small pecuniary consideration, though it was marked 
rare, and was really tires rare, the Aphorisms of Hip- 
pocrates, edited by and with a preface from the hand 
of Francis Rabelais ? And the vellum-bound Tulpius, 
which I came upon in Venice, afterwards my only 
reading when imprisoned in quarantine at Marseilles, 
so that the two hundred and twenty-eight cases he has 
recorded are, many of them, to this day still fresh in 



MEDICAL LIBRARIES. 411 

my memory. And the Schenekius, — the folio filled 
with casus rariores, which had strayed in among the 
rubbish of the bookstall on the boulevard, — and the 
noble old Vesalius with its grand frontispiece not un- 
worthy of Titian, and the fine old Ambroise Pare, long 
waited for even in Paris and long ago, and the colos- 
sal Spigelius with his eviscerated beauties, and Dutch 
Bidloo with its miracles of fine engraving and bad dis- 
section, and Italian Mascagni, the despair of all would- 
be imitators, and pre -Adamite John de Ketam, and 
antediluvian Berengarius Carpensis, — but why multi- 
ply names, every one of which brings back the acces- 
sion of a book which was an event almost like the birth 
of an infant ? 

A library like ours must exercise the largest hospi- 
tality. A great many books may be found in every 
large collection which remind us of those apostolic 
looking old men who figure on the platform at our 
political and other assemblages. Some of them have 
spoken words of wisdom in their day, but they have 
ceased to be oracles ; some of them never had any par- 
ticularly important message for humanity, but they add 
dignity to the meeting by their presence ; they look 
wise, whether they are so or not, and no one grudges 
them their places of honor. Venerable figure-heads, 
what would our platforms be without you ? 

Just so with our libraries. Without their rows of 
folios in creamy vellum, or showing their black backs 
with antique lettering of tarnished gold, our shelves 
would look as insufficient and unbalanced as a column 
without its base, as a statue without its pedestal. And 
do not think they are kept only to be spanked and 
dusted during that dreadful period when their owner 
is but too thankful to become an exile and a wanderer 



412 MEDICAL ESSAYS. 

from the scene of single combats between dead authors 
and living housemaids. Men were not all cowards 
before Agamemnon or all fools before the days of Vir- 
chow and Billroth. And apart from any practical use 
to be derived from the older medical authors, is there 
not a true pleasure in reading the accounts of great 
discoverers in their own words ? I do not pretend to 
hoist up the Bibliotheca Anatomica of Mangetus and 
spread it on my table every day. I do not get out my 
great Albinus before every lecture on the muscles, nor 
disturb the majestic repose of Vesalius every time I 
speak of the bones he has so admirably described and 
figured. But it does please me to read the first de- 
scriptions of parts to which the names of their discover- 
ers or those who have first described them have become 
so joined that not even modern science can part them ; 
to listen to the talk of my old volume as Willis de- 
scribes his circle and Fallopius his aqueduct and Varo- 
lius his bridge and Eustachius his tube and Monro 
his foramen, — all so well known to us in the human 
body ; it does please me to know the very words in 
which Winslow described the opening which bears his 
name, and Glisson his capsule and De Graaf his vesi- 
cle ; I am not content until I know in what language 
Harvey announced his discovery of the circulation, and 
how Spigelius made the liver his perpetual memorial, 
and Malpighi found a monument more enduring than 
brass in the corpuscles of the spleen and the kidney. 

But after all, the readers who care most for the 
early records of medical science and art are the spe- 
cialists who are dividing up the practice of medicine 
and surgery as they were parcelled out, according to 
Herodotus, by the Egyptians. For them nothing is 
too old, nothing is too new, for to their books of all 



MEDICAL LIBRARIES. 413 

others is applicable the saying of D'Alembert that the 
author kills himself in lengthening out what the reader 
kills himself in trying to shorten. 

There are practical books among these ancient vol- 
umes which can never grow old. Would you know 
how to recognize " male hysteria " and to treat it, take 
down your Sydenham ; would you read the experience 
of a physician who was himself the subject of asthma, 
and who, notwithstanding that, in the words of Dr. 
Johnson, " panted on till ninety," you will find it in 
the venerable treatise of Sir John Floyer ; would you 
listen to the story of the King's Evil cured by the royal 
touch, as told by a famous chirurgeon who fully be- 
lieved in it, go to Wiseman ; would you get at first 
hand the description of the spinal disease which long 
bore his name, do not be startled if I tell you to go to 
Pott, — to Percival Pott, the great surgeon of the last 
century. 

There comes a time for every book in a library when 
it is wanted by somebody. It is but a few weeks since 
one of the most celebrated physicians in the country 
wrote to me from a great centre of medical education 
to know if I had the works of Sanctorius, which he had 
tried in vain to find. I could have lent him the " Me- 
dicina Statica," with its frontispiece showing Sancto- 
rius with his dinner on the table before him, in his bal- 
anced chair which sunk with him below the level of 
his banquet-board when he had swallowed a certain 
number of ounces, — an early foreshadowing of Pet- 
tenkofer's chamber and quantitative physiology, — but 
the " Opera Omnia " of Sanctorius I had never met 
with, and I fear he had to do without it. 

I woidd extend the hospitality of these shelves to a 
class of works which we are in the habit of considering 



414 MEDICAL ESSAYS. 

as being outside of the pale of medical science, prop- 
erly so called, and sometimes of coupling with a dis- 
respectful name. Such has always been my own prac- 
tice. I have welcomed Culpeper and Salmon to my 
bookcase as willingly as Dioscorides or Quincy, or 
Paris or Wood and Bache. I have found a place for 
St. John Long, and read the story of his trial for man- 
slaughter with as much interest as the laurel-water case 
in which John Hunter figured as a witness. I would 
give Samuel Hahnemann a place by the side of Samuel 
Thomson. Am I not afraid that some student of imag- 
inative turn and not provided with the needful cere- 
bral strainers without which all the refuse of gimcrack 
intelligences gets into the mental drains and chokes 
them up, — am I not afraid that some such student 
will get hold of the " Organon " or the tfc Maladies 
Chroniques " and be won over by their delusions, and 
so be lost to those that love him as a man of common 
sense and a brother in their high calling? Not in the 
least. If he showed any symptoms of infection I 
would for once have recourse to the principle of similia 
similibus. To cure him of Hahnemann I would pre- 
scribe my favorite homoeopathic antidote, Okie's Bon- 
ninghausen. If that failed, I would order Grauvogl 
as a heroic remedy, and if he survived that uneured, I 
would give him my blessing, if I thought him honest, 
and bid him depart in peace. For me he is no longer 
an individual. He belongs to a class of minds which we 
are bound to be patient with if their Maker sees fit to 
indulge them with existence. We must accept the 
conjuring ultra-ritnalist. the dreamy second adventist, 
the erratic spiritualist, the fantastic homceopathist. as 
not unworthy of philosophic study ; not more unworthy 
of it than the squarers of the circle and the inventors 



MEDICAL LIBRARIES. 415 

of perpetual motion, and the other whimsical vision- 
aries to whom De Morgan has devoted his most in- 
structive and entertaining " Budget of Paradoxes." I 
hope, therefore, that our library will admit the works 
of the so-called Eclectics, of the Thomsonians, if any 
are in existence, of the Clairvoyants, if they have a 
literature, and especially of the Homoeopathists. This 
country seems to be the place for such a collection, 
which will by and by be curious and of more value 
than at present, for Homoeopathy seems to be fol- 
lowing the pathological law of erysipelas, fading out 
where it originated as it spreads to new regions. At 
least I judge so by the following translated extract 
from a criticism of an American work in the " Homoeo- 
patische Rundschau" of Leipzig for October, 1878, 
which I find in the " Homoeopathic Bulletin " for the 
month of November just passed : — 

" While we feel proud of the spread and rise of Ho- 
moeopathy across the ocean, and while the Homoeo- 
pathic works reaching us from there, and published in 
a style such as is unknown in Germany, bear eloquent 
testimony to the eminent activity of our transatlantic 
colleagues, we are overcome by sorrowful regrets at 
the position Homoeopathy occupies in Germany. Such 
a work [as the American one referred to] with us 
would be impossible ; it would lack the necessary sup- 
port." 

By all means let our library secure a good represen- 
tation of the literature of Homoeopathy before it leaves 
us its " sorrowful regrets " and migrates with its sugar 
of milk pellets, which have taken the place of the old 
pilulce micce panis, to Alaska, to "Nova Zembla, or 
the Lord knows where." 

What shall I say in this presence of the duties of a 



416 MEDICAL ESSAYS. 

Librarian? Where have they ever been better per- 
formed than in our own public city library, where the 
late Mr. Jewett and the living Mr. Winsor have shown 
us what a librarian ought to be, — the organizing head, 
the vigilant guardian, the seeker's index, the scholar's 
counsellor ? His work is not merely that of adminis- 
tration, manifold and laborious as its duties are. He 
must have a quick intelligence and a retentive memory. 
He is a public carrier of knowledge in its germs. His 
office is like that which naturalists attribute to the 
bumble-bee, — he lays up little honey for himself, but 
he conveys the fertilizing pollen from flower to flower. 

Our undertaking, just completed, — and just begun 
— has come at the right time, not a day too soon. 
Our practitioners need a library like this, for with all 
their skill and devotion there is too little genuine eru- 
dition, such as a liberal profession ought to be able to 
claim for many of its members. In reading the recent 
obituary notices of the late Dr. Geddings of South 
Carolina, I recalled what our lamented friend Dr. 
Coale used to tell me of his learning and accomplish- 
ments, and I could not help reflecting how few such 
medical scholars we had to show in Boston or New 
England. We must clear up this unilluminated atmos- 
phere, and here, — here is the true electric light which 
will irradiate its darkness. 

The public will catch the rays reflected from the 
same source of light, and it needs instruction on the 
great subjects of health and disease, — needs it sadly. 
It is preyed upon by every kind of imposition almost 
without hindrance. Its ignorance and prejudices re- 
act upon the profession to the great injury of both. 
The jealous feeling, for instance, with regard to such 
provisions for the study of anatomy as are sanctioned 



MEDICAL LIBRARIES. 417 

by the laws in this State and carried out with strict re- 
gard to those laws, threatens the welfare, if not the ex- 
istence of institutions for medical instruction wherever 
it is not held in check by enlightened intelligence. 
And on the other hand the profession has just been 
startled by a verdict against a physician, ruinous in 
its amount, — enough to drive many a hard-working 
young practitioner out of house and home, — a verdict 
which leads to the fear that suits for malpractice may 
take the place of the panel game and child-stealing as 
a means of extorting money. If the profession in this 
State, which claims a high standard of civilization, is 
to be crushed and ground beneath the upper millstone 
of the dearth of educational advantages and the lower 
millstone of ruinous penalties for what the ignorant 
ignorantly shall decide to be ignorance, all I can 

say is 

God save the Common7jealth of Massachusetts! 

Once more, we cannot fail to see that just as astrol- 
ogy has given place to astronomy, so theology, the 
science of Him whom by searching no man can find 
out, is fast being replaced by what we may not im- 
properly call theonomy, or the science of the laws ac- 
cording to which the Creator acts. And since these 
laws find their fullest manifestations for us, at least, 
in rational human natures, the study of anthropology 
is largely replacing that of scholastic divinity. We 
must contemplate our Maker indirectly in human at- 
tributes as we talk of Him in human parts of speech. 
And this gives a sacredness to the study of man in his 
physical, mental, moral, social, and religious nature 
which elevates the faithful students of anthropology 
to the dignity of a priesthood, and sheds a holy light 
on the recorded results of their labors, brought together 

37 



418 MEDICAL ESSATS. 

as they are in such a collection as this which is now 
spread out before us. 

Thus, then, our library is a temple as truly as the 
dome-crowned cathedral hallowed by the breath of 
prayer and praise, where the dead repose and the living 
worship. May it, with all its treasures, be consecrated 
like that to the glory of God, through the contribu- 
tions it shall make to the advancement of sound 
knowledge, to the relief of human suffering, to the 
promotion of harmonious relations between the mem- 
bers of the two noble professions which deal with che 
diseases of the soul and with those of the body, and to 
the common cause in which all good men are working, 
the furtherance of the well-being of their fellow-creat- 
ures ! 

Note. — As an illustration of the statement in the 
last paragraph but one, I take the following notice 
from the " Boston Daily Advertiser," of December 
4th, the day after the delivery of the address : — 

" Prince Lucien Bonaparte is now living in London, 
and is devoting himself to the work of collecting the 
creeds of all religions and sects, with a view to their 
classification, — his object being simply scientific or 
anthropological." 

Since delivering the address, also, I find a leading 
article in the " Cincinnati Lancet and Clinic " of No- 
vember 30th, headed kk The Decadence of Homoe- 
opathy," abundantly illustrated by extracts from the 
"Homoeopathic Times," the leading American organ 
of that sect. 

In the New York " Medical Record " of the same 
date, which I had not seen before the delivery of my 
address, is an account of the action of the Homceo- 



MEDICAL LIBRARIES. 419 

pathic Medical Society of Northern New York, in 
which Hahnemann's theory of " dynamization " is char- 
acterized in a formal resolve as " unworthy the confi- 
dence of the Homoeopathic profession." 

It will be a disappointment to the German Homoe- 
opathists to read in the " Homoeopathic Times " such 
a statement as the following : — 

44 Whatever the influences have been which have 
checked the outward development of Homoeopathy, it 
is plainly evident that the Homoeopathic school, as re- 
gards the number of its openly avowed representatives, 
has attained its majority, and has begun to decline 
both in this country and in England." 

All which is an additional reason for making a col- 
lection of the incredibly curious literature of Homoe- 
opathy before that pseudological inanity has faded out 
like so many other delusions. 



IX. 

SOME OF MY EARLY TEACHERS." 

I had intended that the recitation of Friday last 
should be followed by a few parting words to my class 
and any friends who might happen to be in the lecture- 
room. But I learned on the preceding evening that 
there was an expectation, a desire, that my farewell 
should take a somewhat different form ; and not to 
disappoint the wishes of those whom I was anxious to 
gratify, I made up my mind to appear before you with 
such hasty preparation as the scanty time admitted. 

There are three occasions upon winch a human be- 
ing has a right to consider himself as a centre of inter- 
est to those about him : when he is christened, when he 
is married, and when he is buried. Every one is the 
chief personage, the hero, of his own baptism, his own 
wedding, and his own funeral. 

There are other occasions, less momentous, in which 
one may make more of himself than under ordinary 
circumstances he would think it proper to do; when 
he may talk about himself, and tell his own experi- 
ences, in fact, indulge in a more or less egotistic mono- 
logue without fear or reproach. 

I think I may claim that this is one of those occa- 
sions. I have delivered my last anatomical lecture 

° A Farewell Address to the Medical School of Harvard Uni- 
versity, November 28, 1882. 



SOME OF MY EARLY TEACHERS. 421 

and heard my class recite for the last time. They 
wish to hear from me again in a less scholastic mood 
than that in which they have known me. Will you 
not indulge me in telling you something of my own 
story ? 

This is the thirty-sixth Course of Lectures in which 
I have taken my place and performed my duties as 
Professor of Anatomy. For more than half of my term 
of office I gave instruction in Physiology, after the 
fashion of my predecessors and in the manner then 
generally prevalent in our schools, where the physio- 
logical laboratory was not a necessary part of the ap- 
paratus of instruction. It was with my hearty ap- 
proval that the teaching of Physiology was constituted 
a separate department and made an independent Pro- 
fessorship. Before my time, Dr. Warren had taught 
Anatomy, Physiology, and Surgery in the same course 
of Lectures, lasting only three or four months. As 
the boundaries of science are enlarged, new divisions 
and subdivisions of its territories become necessary. 
In the place of six Professors in 1847, when I first be- 
came a member of the Faculty, I count twelve upon 
the Catalogue before me, and I find the whole number 
engaged in the work of instruction in the Medical 
School amounts to no less than fifty. 

Since I began teaching in this school, the aspect of 
many branches of science has undergone a very re- 
markable transformation. Chemistry and Physiology 
are no longer what they were, as taught by the in- 
structors of that time. We are looking forward to 
the synthesis of new organic compounds ; our artificial 
madder is already in the market, and the indigo-raisers 
are now fearing that their crop will be supplanted by 
the manufactured article. In the living body we talk 



422 MEDICAL ESSAYS. 

of fuel supplied and work done, in movement, in neat, 
just as if we were dealing with a machine of our own 
contrivance. A physiological laboratory of to-day is 
equipped with instruments of research of such ingen- 
ious contrivance, such elaborate construction, that one 
might suppose himself in a workshop where some ex- 
quisite fabric was to be wrought, such as Queens love 
to wear, and Kings do not always love to pay for. 
They are, indeed, weaving a charmed web, for these 
are the looms from which comes the knowledge that 
clothes the nakedness of the intellect. Here are the 
mills that grind food for its hunger, and " is not the 
life more than meat, and the body than raiment ? " 

But while many of the sciences have so changed 
that the teachers of the past would hardly know them, 
it has not been so with the branch I teach, or, rather, 
with that division of it which is chiefly taught in this 
amphitheatre. General anatomy, or histology, on the 
other hand, is almost all new ; it has grown up, mainly, 
since I began my medical studies. I never saw a com- 
pound microscope during my years of study in Paris. 
Individuals had begun to use the instrument, but I 
never heard it alluded to by either Professors or stu- 
dents. In descriptive anatomy I have found little to 
unlearn, and not a great deal that was both new and 
important to learn. Trilling additions are made from 
year to year, not to be despised and not to be over- 
valued. Some of the older anatomical works are still 
admirable, some of the newer ones very much the con- 
trary. I have had recent anatomical plates brought 
me for inspection, and I have actually button-holed the 
book-agent, a being commonly as hard to get rid of as 
the tar-baby in the negro legend, that I might put him 
to shame with the imperial illustrations of the bones 



SOME OF MY EARLY TEACHERS. 423 

and muscles in the great folio of Albinus, published in 
1747, and the unapproached figures of the lymphatic 
system of Mascagni, now within a very few years of a 
century old, and still copied, or, rather, pretended to 
be copied, in the most recent works on anatomy. 

I am afraid that it is a good plan to get rid of old 
Professors, and I am thankful to hear that there is a 
movement for making provision for those who are left 
in need when they lose their offices and their salaries. 
I remember one of our ancient Cambridge Doctors 
once asked me to get into his rickety chaise, and said 
to me, half humorously, half sadly, that he was like an 
old horse, — they had taken off his saddle and turned 
him out to pasture. I fear the grass was pretty short 
where that old servant of the public found himself 
grazing. If I myself needed an apology for holding 
my office so long, I should find it in the fact that 
human anatomy is much the same study that it was in 
the days of Vesalius and Fallopius, and that the 
greater part of my teaching was of such a nature that 
it coidd never become antiquated. 

Let me begin with my first experience as a medical 
student. I had come from the lessons of Judge Story 
and Mr. Ashmun in the Law School at Cambridge. I 
had been busy, more or less, with the pages of Black- 
stone and Chitty, and other text-books of the first year 
of legal study. More or less, I say, but I am afraid 
it was less rather than more. For during that year I 
first tasted the intoxicating pleasure of authorship. A 
college periodical, conducted by friends of mine, still 
undergraduates, tempted me into print, and there is 
no form of lead-poisoning which more rapidly and 
thoroughly pervades the blood and bones and marrow 
thai that which reaches the young author through 



424 MEDICAL ESSAYS. 

mental contact with type-metal. Qui a bu, loir a, — • 
he who has once been a drinker will drink again, says 
the French proverb. So the man or woman who has 
tasted type is sure to return to his old indulgence 
sooner or later. In that fatal year I had my first at- 
tack of authors' lead-poisoning, and I have never got 
quite rid of it from that day to this. But for that I 
might have applied myself more diligently to my legal 
studies, and carried a green bag in place of a stetho- 
scope and a thermometer up to the present day. 

What determined me to give up Law and apply my- 
self to Medicine I can hardly say, but I had from the 
first looked upon that year's study as an experiment. 
At any rate, I made the change, and soon found my- 
self introduced to new scenes and new companionships. 

I can scarcely credit my memory when I recall the 
first impressions produced upon me by sights after- 
wards become so familiar that they could no more dis- 
turb a pulse-beat than the commonest of every-day ex- 
periences. The skeleton, hung aloft like a gibbeted 
criminal, looked grimly at me as I entered the room 
devoted to the students of the school I had joined, just 
as the fleshless figure of Time, with the hour-glass and 
scythe, used to glare upon me in my childhood from 
the " New England Primer." The white faces in the 
beds at the Hospital found their reflection in my own 
cheeks, which lost their color as I looked upon them. 
All this had to pass away in a little time ; I had chosen 
my profession, and must meet its painful and repulsive 
aspects until they lost their power over my sensibili- 
ties. 

The private medical school which I had joined was 
one established by Dr. James Jackson, Dr. Walter 
Channing, Dr. John Ware, Dr. Winslow Lewis, and 



SOME OF MY EARLY TEACHERS. 425 

Dr. George W. Otis. Of the first three gentlemen I 
have either spoken elsewhere or may find occasion to 
speak hereafter. The two younger members of this 
association of teachers were both graduates of our 
University, one of the year 1819, the other of 1818. 

Dr. Lewis was a great favorite with students. He 
was a man of very lively temperament, fond of old 
books and young people, open-hearted, free-spoken, an 
enthusiast in teaching, and especially at home in that 
apartment of the temple of science where nature is 
seen in undress, the anthropotomic laboratory, known 
to common speech as the dissecting-room. He had 
that quality which is the special gift of the man born 
for a teacher, — the power of exciting an interest in 
that which he taught. While he was present the 
apartment I speak of was the sunniest of studios in 
spite of its mortuary spectacles. Of the students I 
met there I best remember James Jackson, Junior, 
full of zeal and playful as a boy, a young man whose 
early death was a calamity to the profession of which 
he promised to be a chief ornament ; the late Rev- 
erend J. S. C. Greene, who, as the prefix to his name 
signifies, afterwards changed his profession, but one of 
whose dissections I remember looking upon with admi- 
ration ; and my friend Mr. Charles Amory, as we call 
him, Dr. Charles Amory, as he is entitled to be called, 
then, as now and always, a favorite with all about him. 
He had come to us from the schools of Germany, and 
brought with him recollections of the teachings of Blu- 
menbach and the elder Langenbeck, father of him 
whose portrait hangs in our Museum. Dr. Lewis was 
our companion as well as our teacher. A good demon- 
strator is, — I will not say as important as a good Pro- 
fessor in the teaching of Anatomy, because I am not 



426 MEDICAL ESSAYS. 

sure that lie is not more important. He comes into 
direct personal relations with the students, — he is one 
of them, in fact, as the Professor cannot be from the 
nature of his duties. The Professor's chair is an insu- 
lating stool, so to speak ; his age, his knowledge, real 
or supposed, his official station, are like the glass legs 
which support the electrician's piece of furniture, and 
cut it off from the common currents of the floor upon 
which it stands. Dr. Lewis enjoyed teaching and 
made his students enjoy being taught. He delighted 
in those anatomical conundrums to answer which keeps 
the student's eyes open and his wits awake. He was 
happy as he dexterously performed tlie tour de merit re 
of the old barber-surgeons, or applied the spica ban- 
dage and taught his scholars to do it, so neatly and 
symmetrically that the aesthetic missionary from the 
older centre of civilization would bend over it in bliss- 
ful contemplation, as if it were a sunflower. Dr. 
Lewis had many other tastes, and was a favorite, not 
only with students, but in a wide circle, professional, 
antiquarian, masonic, and social. 

Dr. Otis was less widely known, but was a fluent 
and agreeable lecturer, and esteemed as a good sur- 
geon. 

I must content myself with this glimpse at myself 
and a few of my fellow-students in Boston. After at- 
tending two courses of Lectures in the school of the 
University, I went to Europe to continue my studies. 

You may like to hear something of the famous Pro- 
fessors of Paris in the days when I was a student in 
the Ecole dc Mddecine, and following the great Hos- 
pital teachers. 

I can hardly believe my own memory when I recall 
the old practitioners and Professors who were still 



SOME OF MY EARLY TEACHERS. 427 

going round the hospitals when I mingled with the 
train of students that attended the morning visits. 
See that bent old man who is groping his way through 
the wards of La Charite. That is the famous Baron 
Boyer, author of the great work on surgery in nine 
volumes, a writer whose clearness of style commends 
his treatise to general admiration, and makes it a kind 
of classic. He slashes away at a terrible rate, they 
say, when he gets hold of the subject of fistula in its 
most frequent habitat, — but I never saw him do more 
than look as if he wanted to cut a good collop out of a 
patient he was examining. The short, square, substan- 
tial man with iron-gray hair, ruddy face, and white 
apron is Baron Larrey, Napoleon's favorite surgeon, 
the most honest man he ever saw, — it is reputed that 
he called him. To go round the H6tel des Invalides 
with Larrey was to live over the campaigns of Napo- 
leon, to look on the sun of Austerlitz, to hear the can- 
nons of Marengo, to struggle through the icy waters 
of the Beresina, to shiver in the snows of the Russian 
retreat, and to gaze through the battle smoke upon the 
last charge of the red lancers on the redder field of 
Waterloo. Larrey was still strong and sturdy as I 
saw him, and few portraits remain printed in livelier 
colors on the tablet of my memory. 

Leave the little group of students which gathers 
about Larrey beneath the gilded dome of the Invalides 
and follow me to the Hotel Dieu, where rules and 
reigns the master-surgeon of his day, at least so far 
as Paris and France are concerned, — the illustrious 
Baron Dupuytren. No man disputed his reign, — ■ 
some envied his supremacy. Lisfranc shrugged his 
shoulders as he spoke of " ce grand homme de l'autre 
c6te de la riviere," that great man on the other side of 



428 MEDICAL ESSAYS. 

the river, but the great man he remained, until he 
bowed before the mandate which none may disobey. 
" Three times," said Bouillaud, " did the apoplectic 
thunderbolt fall on that robust brain," — it yielded at 
last as the old bald cliff that is riven and crashes down 
into the valley. I saw him before the first thunder- 
bolt had descended : a square, solid man, with a high 
and full-domed head, oracular in his utterances, in- 
different to those around him, sometimes, it was said, 
very rough with them. He spoke in low, even tones, 
with quiet fluency, and was listened to with that hush 
of rapt attention which I have hardly seen in any cir- 
cle of listeners unless when such men as ex-President 
John Quincy Adams or Daniel Webster were the 
speakers. I do not think that Dupuytren has left a 
record which explains his influence, but in point of 
fact he dominated those around him in a remarkable 
manner. You must have all witnessed something of 
the same kind. The personal presence of some men 
carries command with it, and their accents silence the 
crowd around them, when the same words from other 
lips might fall comparatively unheeded. 

As for Lisfranc, I can say little more of him than 
that he was a great drawer of blood and hewer of 
members. I remember his ordering a wholesale bleed- 
ing of his patients, right and left, whatever might be 
the matter with them, one morning when a phleboto- 
mizing fit was on him. I recollect his regretting the 
splendid guardsmen of the old Empire, — for what ? 
because they had such magnificent thighs to amputate. 
I got along about as far as that with him, when I 
ceased to be a follower of M. Lisfranc. 

The name of Velpeau must have reached many of 
you, for he died in 1867, and his many works made 



SOME OF MY EARLY TEACHERS. 429 

his name widely known. Coming to Paris in wooden 
shoes, starving, almost, at first, he raised himself to 
great eminence as a surgeon and as an author, and at 
last obtained the Professorship to which his talents 
and learning entitled him. His example may be an 
encouragement to some of my younger hearers who 
are born, not with the silver spoon in their mouths, 
but with the two-tined iron fork in their hands. It is 
a poor thing to take up their milk porridge with in 
their young days, but in after years it will often trans- 
fix the solid dumplings that roll out of the silver 
spoon. So Velpeau found it. He had not what is 
called genius, he was far from prepossessing in aspect, 
looking as if he might have wielded the sledge-hammer 
(as I think he had done in early life) rather than the 
lancet, but he had industry, determination, intelli- 
gence, character, and he made his way to distinction 
and prosperity, as some of you sitting on these benches 
and wondering anxiously what is to become of you in 
the struggle for life will have done before the twen- 
tieth century has got halfway through its first quarter. 
A good sound head over a pair of wooden shoes is a 
great deal better than a wooden head belonging to an 
owner who cases his feet in calf- skin, but a good brain 
is not enough without a stout heart to fill the four 
great conduits which carry at once fuel and fire to that 
mightiest of engines. 

How many of you who are before me are familiarly 
acquainted with the name of Broussais, or even with 
that of Andral ? Both were lecturing at the Ecole de 
Medecine, and I often heard them. Broussais was in 
those days like an old volcano, which has pretty nearly 
used up its fire and brimstone, but is still boiling and 
bubbling in its interior, and now and then sends up a 



430 MEDICAL ESSAYS. 

spirt of lava and a volley of pebbles. His theories of 
gastro-enteritis, of irritation and inflammation as the 
cause of disease, and the practice which sprang from 
them, ran over the fields of medicine for a time like 
flame over the grass of the prairies. The way in which 
that knotty-featured, savage old man would bring out 
the word irritation — with rattling and rolling redu- 
plication of the resonant letter r — might have taught 
a lesson in articulation to Salvini. But Broussais's 
theory was languishing and well-nigh become obsolete, 
and this, no doubt, added vehemence to Ins defence of 
his cherished dogmas. 

Old theories, and old men who cling to them, must 
take themselves out of the way as the new generation 
with its fresh thoughts and altered habits of mind comes 
forward to take the place of that which is dying out. 
This was a truth which the fiery old theorist found it 
very hard to learn, and harder to bear, as it was forced 
upon him. For the hour of his lecture was succeeded 
by that of a younger and far more popular professor. 
As his lecture drew towards its close, the benches, 
thinly sprinkled with students, began to fill up ; the 
doors creaked open and banged back oftencr and oft- 
ener, until at last the sound grew almost continuous, 
and the voice of the lecturer became a leonine growl as 
he strove in vain to be heard over the noise of doors 
and footsteps. 

Broussais was now sixty-two years old. The new 
generation had outgrown his doctrines, and the Pro- 
fessor for whose hour the benches had filled themselves 
belonged to that new generation. Gabriel Andral was 
little more than half the age of Broussais, in the full 
prime and vigor of manhood at thirty-seven years. 
He was a rapid, fluent, fervid, and imaginative speaker, 



SOME OF MY EARLY TEACHERS. 431 

pleasing in aspect and manner, — a strong contrast to 
the harsh, vituperative old man who had just preceded 
him. His Clinique Medicale is still valuable as a col- 
lection of cases, and his researches on the blood, con- 
ducted in association with Gavarret, contributed new 
and valuable facts to science. But I remember him 
chiefly as one of those instructors whose natural elo- 
quence made it delightful to listen to him. I doubt if 
I or my fellow-students did full justice either to him 
or to the famous physician of Hotel Dieu, Chomel. 
We had addicted ourselves almost too closely to the 
words of another master, by whom we were ready to 
swear as against all teachers that ever were or ever 
would be. 

This object of our reverence, I might almost say 
idolatry, was one whose name is well known to most 
of the young men before me, even to those who may 
know comparatively little of his works and teachings. 
Pierre Charles Alexandre Louis, at the age of forty- 
seven, as I recall him, was a tall, rather spare, digni- 
fied personage, of serene and grave aspect, but with a 
pleasant smile and kindly voice for the student with 
whom he came into personal relations. If I summed 
up the lessons of Louis in two expressions, they would 
be these ; I do not hold him answerable for the words, 
but I will condense them after my own fashion in 
French, and then give them to you, expanded some- 
what, in English : — 

Formez toujours des idees nettes. 
Fuyez toujours les a peu pres. 

Always make sure that you form a distinct and clear 
idea of the matter you are considering. 

Always avoid vague approximations where exact es- 



432 MEDICAL ESSAYS. 

timates are possible ; about so many, — about so much, 
instead of the precise number and quantity. 

Now, if there is anything on which the biological 
sciences have prided themselves in these latter years 
it is the substitution of quantitative for qualitative for- 
mulae. The " numerical system," of which Louis was 
the great advocate, if not the absolute originator, was an 
attempt to substitute series of carefully recorded facts, 
rigidly counted and closely compared, for those never- 
ending records of vague, unverifiable conclusions with 
which the classics of the healing art were overloaded. 
The history of practical medicine had been like the 
story of the Danaides. " Experience " had been, from 
time immemorial, pouring its flowing treasures into 
buckets full of holes. At the existing rate of supply 
and leakage they would never be filled ; nothing would 
ever be settled in medicine. But cases thoroughly re- 
corded and mathematically analyzed would always be 
available for future use, and when accumulated in suf- 
ficient number would lead to results which would be 
trustworthy, and belong to science. 

You young men who are following the hospitals 
hardly know how much you are indebted to Louis. I 
say nothing of his Researches on Phthisis or his great 
work on Typhoid Fever. But I consider his modest 
and brief Essay on Bleeding in some Inflammatory 
Diseases, based on cases carefully observed and nu- 
merically analyzed, one of the most important written 
contributions to practical medicine, to the treatment of 
internal disease, of this century, if not since the days 
of Sydenham. The lancet was the magician's wand of 
the dark ages of medicine. The old physicians not only 
believed in its general efficacy as a wonder-worker in 
disease, but they believed that each malady could be 



SOME OF MY EARLY TEACHERS. 433 

successfully attacked from some special part of the 
body, — the strategic point which commanded the seat 
of the morbid affection. On a figure given in the 
curious old work of John de Ketam, no less than 
thirty-eight separate places are marked as the proper 
ones to bleed from, in different diseases. Even Louis, 
who had not wholly given up venesection, used now and 
then to order that a patient suffering from headache 
should be bled in the foot, in preference to any other 
part. 

But what Louis did was this : he showed by a strict 
analysis of numerous cases that bleeding did not stran- 
gle, — jugulate was the word then used, — acute dis- 
eases, more especially pneumonia. This was not a re- 
form, — it was a revolution. It was followed up in 
this country by the remarkable Discourse of Dr. Jacob 
Bigelow upon Self -Limited Diseases, which has, I be- 
lieve, done more than any other work or essay in our 
own language to rescue the practice of medicine from 
the slavery to the drugging system which was a part 
of the inheritance of the profession. 

Yes, I say, as I look back on the long hours of the 
many days I spent in the wards and in the autopsy 
room of La Pitie, where Louis was one of the attend- 
ing physicians, — yes, Louis did a great work for prac- 
tical medicine. Modest in the presence of nature, 
fearless in the face of authority, unwearying in the pur- 
suit of truth, he was a man whom any student might 
be happy and proud to claim as his teacher and his 
friend, and yet, as I look back on the days when I fol- 
lowed his teachings, I feel that I gave myself up too 
exclusively to his methods of thought and study. 

There is one part of their business which certain 
medical practitioners are too apt to forget ; namely, 

28 



434 MEDICAL ESSAYS. 

that what they should most of all try to do is to ward 
off disease, to alleviate suffering, to preserve life, or at 
least to prolong it if possible. It is not of the slight- 
est interest to the patient to know whether three or 
three and a quarter cubic inches of his lung are hepa- 
tized. His mind is not occupied with thinking of the 
curious problems which are to be solved by his own 
autopsy, — whether this or that strand of the spinal 
marrow is the seat of this or that form of degenera- 
tion. He wants something to relieve his pain, to miti- 
gate the anguish of dyspnoea, to bring back motion 
and sensibility to the dead limb, to still the tortures of 
neuralgia. What is it to him that you can localize 
and name by some uncouth term the disease which you 
could not prevent and which you cannot cure? An old 
woman who knows how to make a poultice and how to 
put it on, and does it tuto, cito, jucunde, just when 
and where it is wanted, is better, — a thousand times 
better in many cases, — than a staring pathologist, who 
explores and thumps and doubts and guesses, and tells 
his patient he will be better to-morrow, and so goes 
home to tumble his books over and make out a diag- 
nosis. 

But in those days, I, like most of my fellow students, 
was thinking much more of " science " than of prac- 
tical medicine, and I believe if we had not clung so 
closely to the skirts of Louis and had followed some 
of the coui'ses of men like Trousseau, — therapeutists, 
who gave special attention to curative methods, and 
not chiefly to diagnosis, — it would have been better 
for me and others. One thing, at any rate, we did 
learn in the wards of Louis. We learned that a very 
large proportion of diseases get well of themselves, 
without any special medication, — the great fact for- 



SOME OF MY EARLY TEACHERS. 435 

mulated, enforced, and popularized by Dr. Jacob Big- 
elow in the Discourse referred to. We wt? learned the 
habit of drugging for its own sake. This detestable 
practice, which I was almost proscribed for condemn- 
ing somewhat too epigrammatically a little more than 
twenty years ago, came to us, I suspect, in a consider- 
able measure from the English " general practition- 
ers," a sort of prescribing apothecaries. You remem- 
ber how, when the city was besieged, each artisan who 
was called upon in council to suggest the best means 
of defence recommended the articles he dealt in : the 
carpenter, wood ; the blacksmith, iron ; the mason, 
brick ; until it came to be a puzzle to know which to 
adopt. 

" Then the shoemaker said, Hang your walls with new boots" 

and gave good reasons why these should be the best of 
all possible defences. Now the " general practitioner " 
charged, as I understand, for his medicine, and in that 
way got paid for his visit. Wherever this is the prac- 
tice, medicine is sure to become a trade, and the people 
learn to expect drugging, and to consider it necessary, 
because drugs are so universally given to the patients 
of the man who gets his living by them. 

It was something to have unlearned the pernicious 
habit of constantly giving poisons to a patient, as if 
they were good in themselves, of drawing off the blood 
which he would want in his struggle with disease, of 
making him sore and wretched with needless blisters, 
of turning his stomach with unnecessary nauseous 
draughts and mixtures, — only because he was sick 
and something must be done. But there were positive 
as well as negative facts to be learned, and some of 
us, I fear, came home rich in the negatives of the ex- 



436 MEDICAL ESSAYS. 

pectant practice, poor in the resources which many a 
plain country practitioner had ready in abundance for 
the relief and the cure of disease. No one instructor 
can be expected to do all for a student which he re- 
quires. Louis taught us who followed him the love of 
truth, the habit of passionless listening to the teach- 
ings of nature, the most careful and searching methods 
of observation, and the sine means of getting at the 
results to be obtained from them in the constant em- 
ployment of accurate tabulation. He was not a showy, 
or eloquent, or, I should say, a very generally popular 
man, though the favorite, almost the idol, of many stu- 
dents, especially Grenevese and Bostonians. But he 
was a man of lofty and admirable scientific character, 
and his work will endure in its influences long after 
his name is lost sight of save to the faded eyes of the 
student of medical literature. 

Many other names of men more or less famous in 
their day, and who were teaching while T was in Paris, 
come up before me. They are but empty sounds for 
the most part in the ears of persons of not more than 
middle age. Who of you knows anything of Riche- 
rand, author of a very popular work on Physiology, 
commonly put into the student's hands when I first 
began to ask for medical text-books? I heard him 
lecture once, and have had his image with me ever 
Bince as that of an old, worn-out man, — a venerable 
but dilapidated relic of an effete antiquity. To verify 
this impression I have just looked out the dates of his 
birth and death, and find that he was eighteen years 
younger than the speaker who is now addressing you. 
There is a terrible parallax between the period before 
thirty and that after threescore and ten, as two men of 
those ages look, one with naked eyes, one through his 



SOME OF MY EARLY TEACHERS. 437 

spectacles, at the man of fifty and thereabout. Ma- 
gendie, I doubt not you have all heard of. I attended 
but one of his lectures. I question if one here, unless 
some contemporary of my own has strayed into the 
amphitheatre, — knows anything about Marjolin. I 
remember two things about his lectures on surgery, — 
the deep tones of his voice as he referred to his oracle, 
— the earlier writer, Jean Louis Petit, — and his for- 
midable snuff-box. What he taught me lies far down, 
I doubt not, among the roots of my knowledge, but 
it does not flower out in any noticeable blossoms, or 
offer me any very obvious fruits. Where now is the 
fame of Bouillaud, Professor and Deputy, the San- 
grado of his time ? Where is the renown of Piorry, 
percussionist and poet, expert alike in the resonances 
of the thoracic cavity and those of the rhyming vocab- 
ulary ? I think life has not yet done with the viva- 
cious Ricord, whom I remember calling the Voltaire 
of pelvic literature, — a sceptic as to the morality of 
the race in general, who would have submitted Diana 
to treatment with his mineral specifics, and ordered a 
course of blue pills for the vestal virgins. 

Ricord was born at the beginning of the century, 
and Piorry some years earlier. Cruveilhier, who died 
in 1874, is still remembered by his great work on path- 
ological anatomy ; his work on descriptive anatomy has 
some things which I look in vain for elsewhere. But 
where is Civiale, — where are Orfila, Gendrin, Rostan, 
Biett, Alibert, — jolly old Baron Alibert, whom I re- 
member so well in his broad-brimmed hat, worn a lit- 
tle jauntily on one side, calling out to the students in 
the court-yard of the Hospital St. Louis, " Enfans de 
la methode naturelle, etes-vous tous ici? " " Children 
of the natural method [his own method of classifica- 



438 MEDICAL ESSAYS. 

tion of skin diseases], are you all here? " All here, 
then, perhaps ; all where, now? 

My show of ghosts is over. It is always the same 
story that old men tell to younger ones, some few of 
whom will in their turn repeat the tale, only with al- 
tered names, to their children's children. 

Like phantoms painted on the magic slide. 
Forth from the darkness of the past we glide, 
As living shadows for a moment seen 
In airy pageant on the eternal screen, 
Traced by a ray from one unchanging flame, 
Then seek the dust and stillness whence we came. 

Dr. Benjamin Waterhouse, whom I well remember, 
came back from Leyden, where he had written his 
Latin graduating thesis, talking of the learned Gau- 
bius and the late illustrious Boerhaave and other dead 
Dutchmen, of whom you know as much, most of you, 
as you do of Noah's apothecary and the family phy- 
sician of Methuselah, whoso prescriptions seem to have 
been lost to posterity. Dr. Lloyd came back to Boston 
full of the teachings of Cheselden and Sharpe, Wil- 
liam Hunter, Smellie, and Warner ; Dr. James Jack- 
son loved to tell of Mr. Cline and to talk of Mr. John 
Hunter ; Dr. Reynolds would give you his recollections 
of Sir Astley Cooper and Mr. Abernethy ; I have 
named the famous Frenchmen of my student days ; 
Leyden, Edinburgh, Loudon. Paris, were each in turn 
the Mecca of medical students, just as at the present 
day Vienna and Berlin are the centres where our 
young men crowd for instruction. These also must 
sooner or later yield their precedence and pass the 
torch they hold to other hands. Where shall it next 
flame at the head of the long procession ? Shall it 
find its old place on the shores of the Gulf of Salerno, 



SOME OF MY EARLY TEACHERS. 439 

or shall it mingle its rays with the northern aurora up 
among the fiords of Norway, — or shall it be borne 
across the Atlantic and reach the banks of the Charles, 
where Agassiz and Wyman have taught, where Hagen 
still teaches, glowing like his own Lampyris splendi- 
dula, with enthusiasm, where the first of American 
botanists and the ablest of American surgeons are still 
counted in the roll of honor of our great University ? 

Let me add a few words which shall not be other 
than cheerful, as I bid farewell to this edifice which I 
have known so long. I am grateful to the roof which 
has sheltered me, to the floors which have sustained 
me, though I have thought it safest always to abstain 
from anything like eloquence, lest a burst of too em- 
phatic applause might land my class and myself in the 
cellar of the collapsing structure, and bury us in the 
fate of Korah, Dathan, and Abiram. I have helped 
to wear these stairs into hollows, — stairs which I trod 
when they were smooth and level, fresh from the plane. 
There are just thirty-two of them, as there were five 
and thirty years ago, but they are steeper and harder 
to climb, it seems to me, than they were then. I re- 
member that in the early youth of this building, the 
late Dr. John K. Mitchell, father of our famous Dr. 
Weir Mitchell, said to me as we came out of the Dem- 
onstrator's room, that some day or other a whole class 
would go heels over head down this graded precipice, 
like the herd told of in Scripture story. This has 
never happened as yet ; I trust it never will. I have 
never been proud of the apartment beneath the seats, 
in which my preparations for lecture were made. But 
I chose it because I could have it to myself, and I 
resign it, with a wish that it were more worthy of re- 
gret, into the hands of my successor, with my parting 



440 MEDICAL ESSAYS. 

benediction. Within its twilight precincts I have often 
prayed for light, like Ajax, for the daylight found 
scanty entrance, and the gaslight never illuminated its 
dark recesses. May it prove to him who comes after 
me like the cave of the Sibyl, out of the gloomy depths 
of which came the oracles which shone with the rays 
of truth and wisdom ! 

This temple of learning is* not surrounded by the 
mansions of the great and the wealthy. No stately 
avenues lead up to its facades and porticoes. I have 
sometimes felt, when convoying a distinguished stran- 
ger through its precincts to its door, that he might 
question whether star-eyed Science had not missed her 
way when she found herself in this not too attractive 
locality. I cannot regret that we — you, I should say 
— are soon to migrate to a more favored region, and 
carry on your work as teachers and as learners in am- 
pler halls and under far more favorable conditions. 

I hope that I may have the privilege of meeting you 
there, possibly may be allowed to add my words of 
welcome to those of my former colleagues, and in that 
pleasing anticipation I bid good-by to this scene of my 
long labors, and, for the present at least, to the friends 
with whom I have been associated. 



APPENDIX 



NOTES TO THE ADDRESS OX CURRENTS AND COUNTER- 
CURRENTS IN MEDICAL SCIENCE. 

Some passages contained in the original manuscript of the 
Address, and omitted in the delivery on account of its length, 
are restored in the text or incorporated with these Notes. 

Note A. — (p. 188.) 
There is good reason to doubt whether the nitrate of silver 
has any real efficacy in epilepsy. It has seemed to cure many 
cases, but epilepsy is a very uncertain disease, and there is 
hardly anything which has not been supposed to cure it. Dr. 
Copland cites many authorities in its favor, most especially 
Lombard's cases. But De la Berge and Monneret (Comp. de 
Med. Paris), 1839, analyze these same cases, eleven in number, 
and can only draw the inference of a very questionable value in 
the supposed remedy. Dr. James Jackson says that relief of 
epilepsy is not to be attained by any medicine with which he is 
acquainted, but by diet. (Letters to a Young Physician, p. 6 7.) 
Guy Patin, Dean of the Faculty of Paris, Professor at the Royal 
College, Author of the Antimonial Martyrology, a wit and a man 
of sense and learning, who died almost two hundred years ago, 
had come to the same conclusion, though the chemists of his 
time boasted of their remedies. "Did you ever see a case of 
epilepsy cured by nitrate of silver? " I said to one of the oldest 
and most experienced surgeons in this country. " Never," was 
his instant reply. Dr. TwitchelPs experience was very similar. 
How, then, did nitrate of silver come to be given for epilepsy? 
Because, as Dr. Martin has so well reminded us, lunatics were 
considered formerly to be under the special influence of Luna, 
the moon (which Esquirol, be it observed, utterly denies), and 
lunar caustic, or nitrate of silver, is a salt of that metal which 



442 APPENDIX. 

was called lima from its whiteness, and of course must be in the 
closest relations with the moon. It follows beyond all reason- 
able question that the moon's metal, silver, and its preparations, 
must be the specific remedy for moon-blasted maniacs and epi- 
leptics! 

Yet the practitioner who prescribes the nitrate of silver sup- 
poses he is guided by the solemn experience of the past, instead 
of by its idle fancies. He laughs at those old physicians who 
placed such confidence in the .right hind hoof of an elk ns a rem- 
edy for the same disease, and leaves the record of his own belief 
in a treatment quite as fanciful and far more objectionable, 
written in indelible ink upon a living tablet where he who runs 
may read it for a whole generation, if nature spares his walking 
advertisement so long. 

Note B. —(p. 201.) 

The presumption that a man is innocent until he is proved 
guilty, does not mean that there are no rogues, but lays the onus 
probandi on the party to which it properly belongs. So with 
this proposition. A noxious agent should never be employed in 
sickness unless there is ample evidence in the particular case to 
overcome the general presumption against all such agents, — 
and the evidence i- very apt to be defective. 

The miserable delusion of Homoeopathy builds itself upon an 
axiom directly the opposite of this; namely, that the sick are to 
be cured by poisons. Similia similibus curantur means exactly 
this. It is simply a theory of universal poisoning, nullified in 
practice by the infinitesimal contrivance. The only way to kill 
it and all similar fancies, and to throw every quack nostrum into 
discredit, is to root out completely the suckers of the old rotten 
superstition that whatever is odious or noxious is likely to be 
good for disease. The current of sound practice with ourselves 
is, I believe, setting fast in the direction I have indicated in the 
above proposition. To uphold the exhibition of noxious agents 
in disease, as the ru'<\ instead of admitting them cautiously and 
reluctantly as the exception, is, as I think, an eddy of opinion in 
the direction of the barbarism out of which we believe our art is 
escaping. It is only through the enlightened sentiment and ac- 
tion of the Medical Profession that the community can be 
brought to acknowledge that drugs should " always be regarded 
as evils." 



APPENDIX. 443 

It is true that some suppose, and our scientific and thoughtful 
associate, Dr. Gould, has half countenanced the opinion, that 
there may yet be discovered a specific for every disease. Let 
us not despair of the future, but let us be moderate in our ex- 
pectations. When an oil is discovered that will make a bad 
watch keep good time ; when a recipe is given which will turn 
an acephalous foetus into a promising child; when a man can 
enter the second time into his mother's womb and give her back 
the infirmities which twenty generations have stirred into her 
blood, and infused into his own through hers, we may be pre- 
pared to enlarge the National Pharmacopoeia with a list of spe- 
cifics for everything but old age, — and possibly for that also. 

Note C. — (p. 203.) 

The term specific is used here in its ordinary sense, without 
raising the question of the propriety of its application to these 
or other remedies. 

The credit of introducing Cinchona rests between the Jesuits, 
the Countess of Chinchon, the Cardinal de Lugo, and Sir Robert 
Talbor, who employed it as a secret remedy. (Pereira.) Mer- 
cury as an internal specific remedy was brought into use by that 
"impudent and presumptuous quack," as he was considered, 
Paracelsus. (Encyc. Brit. art. "Paracelsus.") Arsenic was 
introduced into England as a remedy for intermittents by Dr. 
Fowler, in consequence of the success of a patent medicine, the 
Tasteless Ague Drops, which were supposed, " probably with 
reason," to be a preparation of that mineral. (JRees's Cyc. 
art. " Arsenic") Colchicum came into notice in a similar way, 
from the success of the Eau Medicinale of M. Husson, a French 
military officer. (Pereira.) Iodine was discovered by a salt- 
petre manufacturer, but applied by a physician in place of the 
old remedy, burnt sponge, which seems to owe its efficacy to it. 
(Dunglison, New Remedies.) As for Sulphur, " the common 
people have long used it as an ointment" for scabies. (Rees's 
Cyc. art. " Scabies.") The modern antiscorbutic regimen is 
credited to Captain Cook. " To his sagacity we are indebted 
for the first impulse to those regulations by which scorbutus is 
so successfully prevented in our navy." (Lond. Cyc. Prac. Med. 
art. " Scorbutus.") Iron and various salts which enter into the 
normal composition of the human body do not belong to the ma- 
teria medico, by our definition, but to the materia alimentaria. 



444 APPENDIX. 

For the first introduction of iron as a remedy, see Pereira, who 
gives a very curious old story. 

The statement in the text concerning a portion of the materia 
medica stands exactly as delivered, and is meant exactly as it 
stands. No denunciation of drugs, as sparingly employed by a 
wise physician, was or is intended. If, however, as Dr. Gould 
stated in his " valuable and practical discourse" to which the 
Massachusetts Medical Society "listened with profit as well as 
interest," " Drugs, in themselves considered, may always be re- 
garded as evils," — any one who chooses may question whether 
the evils from their abuse are, on the whole, greater or less than 
the undoubted benefits obtained from their proper use. The 
large exception of opium, wine, specifics, and ancesthetics, made 
in the text, takes off enough from the useful side, as I fully be- 
lieve, to turn the balance ; so that a vessel containing none of 
these, but loaded with antimony, strychnine, acetate of lead, 
aloes, aconite, lobelia, lapis infernalis, stercus diaboli, tormen- 
tilla, and other approved, and, in skilful hands, really useful 
remedies, brings, on the whole, more harm than good to the 
port it enters. 

" It is a very narrow and unjust view of the practice of medi- 
cine, to suppose it to consist altogether in the use of powerful 
drugs, or of drugs of any kind. Far from it." " The physician 
may do very much for the welfare of the sick, more than others 
can do, although he does not, even in the major part of cases, 
undertake to control and overcome the disease by art. It was 
with these views that I never reported any patient cured at our 
hospital. Those who recovered their health were reported as 
irrll, not implying that they were made so by the active treat- 
ment they had received there. But it was to be understood that 
all patients received in that house were to be cured, that is, 
taken care of." {Letter* to a Young Physician, by James Jack- 
son, M. D., Boston, 1855.) 

" Hygienic rules, properly enforced, fresh air, change of air, 
travel, attention to diet, good and appropriate food judiciously 
regulated, together with the administration of our tonics, porter, 
ale, wine, iron, etc., supply the diseased or impoverished system 
with what Mr. Gull, of St. Bartholomew's Hospital, aptly calls 
* the raw material of the blood; ' and we believe that if any real 
improvement has taken place in medical practice, independently 
of those truly valuable contributions we have before described, 



APPENDIX. 445 

it is in the substitution of tonics, stimulants, and general man- 
agement, for drastic cathartics, for bleeding, depressing agents, 
including mercury, tartar emetics, etc., so much in vogue dur- 
ing the early part even of this century.*' (F. P. Porcher, in 
Charleston Med. Journal and Review for January, 1860.) 



